天津市无症状人群LDCT肺癌筛查基线研究

Results of Low-Dose Computer Tomography Lung Cancer Baseline Screening in Asymptomatic Participants from Tianjin

目的探讨低剂量CT(LDCT)早期肺癌筛查在天津市无症状人群中的基线扫描效果。方法 1956例天津地区无症状人群参加胸部LDCT筛查,参照NCCN肺癌筛查指南将入组人群分为高危、中危、低危三组。以检出至少一个非钙化结节为LDCT筛查阳性结果。采用χ~2检验或Fisher确切概率法,分析三组之间的结节检出率和肺癌检出情况,并对检出肺气肿、冠状动脉钙化人群进行健康指导以提高LDCT筛查的成本-效益。结果 1956例无症状人群中,312例行胸部LDCT筛查至少检出1枚非钙化结节,基线结节检出率为15.95%。高危、中危和低危组的基线阳性率分别为20.98%(94/448)、17.11%(77/450)和13.33%(141/1058)。17例受检者检出肺癌病灶17个,16例获得病理结果,13例腺癌,3例鳞癌;肺癌检出率0.87%,其中男性8例,女性9例;高危组5例,中危组3例,低危组9例,高、中、低危组的肺癌检出率分别为1.12%、0.67%、0.85%,三组之间肺癌检出率差异均无统计学意义(P>0.05)。0～Ⅰ期肺癌所占比例为73.33%。基线扫描共检出500例冠状动脉钙化,121例肺气肿。结论 LDCT肺癌筛查可以提高肺癌的早期诊断率,≥40岁的中、低危人群应与高危人群一样受到重视。

Objective To explore the effect of low-dose computed tomography(LDCT)baseline screening for lung cancer in asymptomatic participants from TianJinlocal community.Methods The 1956 asymptomatic participants underwent chest low dose spiral CT.According to the National Comprehensive Cancer Network(NCCN)guideline for lung cancer,all participants were assigned to three groups,namely high-risk,moderate-risk and low-risk groups.The positive results were identified as at least one non-calcified nodule detected.The detected rates of nodules as well as pulmonary carcinoma in different groups were analyzed by the chi-square test or Fisher’s exact test.In order to improve the cost-effectiveness of LDCT,we also gave some clinical advices to the persons who detected coronary calcification or emphysema.Results A total of 1956 asymptomatic participants underwent screening,with a result of 312(15.95%)participants having at least one non-calcified nodule.In various risk status group of the participants,the percentage of positive results of baseline CT were 20.98%(94/448),17.11%(77/450)and 13.33%(141/1058).A total of 17 participants(17 lesions)were diagnosed as lung cancer(8 in men,9 in women),16 of them obtained histologic type(13 adenocarcinoma,3 squamous cell carcinoma);the detection rate of lung cancer was 0.87%(17/1956).5(1.12%)cases belonged to high-risk group,3(0.67%)cases belonged to moderate-risk group,9(0.85%)cases belonged to low-risk group;The difference of detection rate of lung cancer in different groups were not statistically significant(P>0.05).The percentage of early lung cancer was 73.33%.500 Coronary calcifications and 121 emphysemas were detected in LDCT baseline screening.Conclusion The LDCT screening may be helpful for early detection of lung cancer in moderate-risk and low-risk group aged more than 40 years old as well as in high-risk group.