无症状健康体检者胸部低剂量CT在早期肺癌筛查中的实用价值

The value of low dose CT in early lung cancer screening in asymptomatic healthy patients

目的评估无症状健康体检者胸部低剂量螺旋CT(LDCT)在早期肺癌筛查中的实用价值。方法选择2016年1月—2017年12月在内蒙古自治区呼和浩特市第一医院进行无症状健康体检者3730例,均经LDCT和X线胸片检查,对比分析诊断的准确性,评价LDCT在早期肺癌筛查中的实用价值。结果所有受检者顺利完成LDCT扫描和X线胸片筛查,检查图像达到临床诊断标准。3730例受检者中LDCT检查阳性病变者1112例,其中肺癌2.96%,肺结核8.63%,结节38.31%,支气管扩张3.59%,肺气肿15.82%,肺大疱10.70%,炎症4.13%,其他15.82%。其中426例肺结节中,炎性结节38.26%,实性结节41.31%,磨玻璃样结节19.95%。3730例受检者中X线胸片检查阳性病变者812例,包括肺癌2.95%,肺结核11.20%,结节27.22%,支气管扩张3.94%,肺气肿20.32%,肺大疱11.94%,炎症4.80%,其他良性陈旧性疾病17.61%。LDCT检查阳性组和X线胸片检查阳性组患者的肺癌、肺部结节、其他疾病的阳性结果例数、检出率及检出准确率比较,差异均有统计学意义(P<0.05)。结论在年龄≥40岁人群的大规模体检中,LDCT对早期肺癌的筛查具有良好的诊断价值。

Objective To evaluate the value of low-dose spiral CT(LDCT)in early lung cancer screening in asymptomatic healthy patients.Methods 3,730 cases of asymptomatic healthy patients who underwent physical examination in our hospital from January 2016 to December 2017 were selected,all of whom were examined by LDCT and chest X-ray,and the diagnostic accuracy was compared and analyzed to evaluate the practical value of LDCT in early lung cancer screening.Results All subjects successfully completed LDCT scan and chest X-ray screening,and the examination images met the clinical diagnostic criteria.Among the 3730 patients,1112 had LDCT positive lesions,including 2.96%of lung cancer,8.63%of tuberculosis,38.31%of nodules,3.59%of bronchiectasis,15.82%of emphysema,10.70%of bullae,4.13%of inflammation,and 15.82%of others.The pulmonary nodules in 426 cases included 38.26%of inflammatory nodules,41.31%,of solid nodules and 19.95%of ground glass nodules.Among the 3730 patients,812 had positive lesions screened by chest X-ray,including 2.95%of lung cancer,11.20%of tuberculosis,27.22%of nodules,3.94%of bronchiectasis,20.32%of emphysema,11.94%of bullae,4.80%of inflammation,and 17.61%of other benign old diseases.The number of positive cases,detection rate and detection accuracy of lung cancer,pulmonary nodules and other diseases in the two groups were compared,showing statistically significant differences(P<0.05),which fully demonstrated that the LDCT group was significantly better than the X-ray chest X-ray screening group,and had good diagnostic value.However,for pulmonary nodules,it is difficult to determine the nature of X-ray chest X-ray screening,only the existence of nodules of sufficient size can be diagnosed,and the size of lesions in other diseases is still the main reason for the low accuracy of X-ray diagnosis.Conclusions LDCT has good diagnostic value in early lung cancer screening in large scale physical examination of patients≥40 years old.