Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung canc...Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect.Methods: A decision tree model with three scenarios(low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort(100,000 smokers aged45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality(primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables.Results: Among the 100,000 subjects, there were 448,541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively(17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, lowdose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths(relative numbers) with low-dose CT screening in the worst and optimal cases were16(5.4%) and 288(40.2%) over no screening, respectively.Conclusions: In terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China.However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.展开更多
Lung cancer is associated with a heavy cancer-related burden in terms of patients’physical and mental health worldwide.Two randomized controlled trials,the US-National Lung Screening Trial(NLST)and Nederlands-Leuvens...Lung cancer is associated with a heavy cancer-related burden in terms of patients’physical and mental health worldwide.Two randomized controlled trials,the US-National Lung Screening Trial(NLST)and Nederlands-Leuvens Longkanker Screenings Onderzoek(NELSON),indicated that low-dose CT(LDCT)screening results in a statistically significant decrease in mortality in patients with lung cancer,LDCT has become the standard approach for lung cancer screening.However,many issues in lung cancer screening remain unresolved,such as the screening criteria,high false-positive rate,and radiation exposure.This review first summarizes recent studies on lung cancer screening from the US,Europe,and Asia,and discusses risk-based selection for screening and the related issues.Second,an overview of novel techniques for the differential diagnosis of pulmonary nodules,including artificial intelligence and molecular biomarker-based screening,is presented.Third,current explorations of strategies for suspected malignancy are summarized.Overall,this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.展开更多
Objective: To investigate the clinical diagnostic value of peripheral lung cancer using multi-slice CT (MSCT) perfu- sion imaging and the relationship with microvessel density (MVD). Methods: 38 patients with pulmonar...Objective: To investigate the clinical diagnostic value of peripheral lung cancer using multi-slice CT (MSCT) perfu- sion imaging and the relationship with microvessel density (MVD). Methods: 38 patients with pulmonary masses proved by pathology including 25 cases of peripheral lung cancer and 13 cases of benign masses were studied prospectively with GE Lightspeed Qx/I plus 16-slice helical CT perfusion imaging, and 25 patients with lung cancer were comparative studied with its MVD calculated using LSAB. With the CT perfusion 2-body tumor software, the parameters of CT perfusion including blood value (BV), blood flow (BF), mean transit time (MTT) and permeability surface (PS) were analyzed. Results: The four param- eter values in lung cancer were all higher than that in pulmonary benign masses, and there were significant differences among BV, MTT and PS (P<0.05), especially in BV (P<0.01). The MVD value of lung cancer was higher than that of pulmonary benign masses (P<0.05), and the MVD of adenocarcinoma was higher than that of squamous cell carcinoma (P<0.05). In 25 cases with lung cancer, there was positive correlation only between BV and MVD value (r=0.852, P<0.01). Conclusion: It is helpful to diagnose the peripheral lung cancer with MSCT perfusion imaging and to differentiate from pulmonary benign masses, its bases are MVD pathologically.展开更多
目的探究多层螺旋CT低剂量扫描在肺部小结节鉴别诊断中的应用价值。方法选取2016年2月~2018年10月我院收治的100例肺部小结节患者,所有患者均行多层螺旋CT低剂量扫描,分析多层螺旋CT低剂量扫描的灵敏度、特异度及准确度、对比良、恶性...目的探究多层螺旋CT低剂量扫描在肺部小结节鉴别诊断中的应用价值。方法选取2016年2月~2018年10月我院收治的100例肺部小结节患者,所有患者均行多层螺旋CT低剂量扫描,分析多层螺旋CT低剂量扫描的灵敏度、特异度及准确度、对比良、恶性结节影像学特征及不同病变类型的CT值。结果多层螺旋CT低剂量扫描在诊断肺部小结节中灵敏度为92.86%、特异度为88.64%、准确度为91.00%;相较于恶性结节,良性结节边缘清晰度、内部钙化检出率较高,边缘分叶状或不规则状、毛刺征,内部结构均匀检出率较低,差异有统计学意义(P<0.05);卫星灶在良性与恶性结节中的检出率比较,差异无统计学意义(P>0.05);良性结节30 s、90 s及180 s CT值均小于恶性结节,差异有统计学意义(P<0.05)。结论多层螺旋CT低剂量扫描在肺部小结节鉴别中具有较高的应用价值,可有效鉴别结节性质,且检查中辐射剂量较低,应用安全性高。展开更多
Following publication of the results of the National Lung Screening Trial in the United States,a randomized controlled trial in Italy(ITALUNG)and two simulation studies in China reported similar findings in 2017 favor...Following publication of the results of the National Lung Screening Trial in the United States,a randomized controlled trial in Italy(ITALUNG)and two simulation studies in China reported similar findings in 2017 favoring lung cancer screening with low-dose computed tomography among smokers.With such advances in lung cancer screening,worldwide interest has gradually shifted from evaluating whether refining lung cancer screening protocols is effective in preventing deaths.However,there are several practical problems to be resolved,including the balance of enroll-ment criteria and cost effectiveness,precise measurements to reduce false positive findings,risk-based optimization of screening frequency,challenges associated with cancer heterogeneity,strategies to combine image screening with novel biomarkers,dynamic monitoring of the natural history of cancer,accurate identification and diagnosis of cases among huge populations,and the impact of tobacco control policy and environment protection.As one in three individuals with lung cancer worldwide resides in China,these questions pose great challenges as well as research opportunities for population screening programs in China.展开更多
基金supported by Peking Union Medical College Youth Fund and the Fundamental Research Funds for the Central Universities(No.2017310049)
文摘Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect.Methods: A decision tree model with three scenarios(low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort(100,000 smokers aged45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality(primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables.Results: Among the 100,000 subjects, there were 448,541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively(17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, lowdose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths(relative numbers) with low-dose CT screening in the worst and optimal cases were16(5.4%) and 288(40.2%) over no screening, respectively.Conclusions: In terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China.However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.
基金This study was supported by the China National Science Foundation(Grant Nos.82022048 and 81871893)the Key Project of Guangzhou Scientific Research Project(Grant No.201804020030).
文摘Lung cancer is associated with a heavy cancer-related burden in terms of patients’physical and mental health worldwide.Two randomized controlled trials,the US-National Lung Screening Trial(NLST)and Nederlands-Leuvens Longkanker Screenings Onderzoek(NELSON),indicated that low-dose CT(LDCT)screening results in a statistically significant decrease in mortality in patients with lung cancer,LDCT has become the standard approach for lung cancer screening.However,many issues in lung cancer screening remain unresolved,such as the screening criteria,high false-positive rate,and radiation exposure.This review first summarizes recent studies on lung cancer screening from the US,Europe,and Asia,and discusses risk-based selection for screening and the related issues.Second,an overview of novel techniques for the differential diagnosis of pulmonary nodules,including artificial intelligence and molecular biomarker-based screening,is presented.Third,current explorations of strategies for suspected malignancy are summarized.Overall,this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.
基金Supported by a grant from the Scientific Research Foundation of the Educational Department of Liaoning province (No. 20272277).
文摘Objective: To investigate the clinical diagnostic value of peripheral lung cancer using multi-slice CT (MSCT) perfu- sion imaging and the relationship with microvessel density (MVD). Methods: 38 patients with pulmonary masses proved by pathology including 25 cases of peripheral lung cancer and 13 cases of benign masses were studied prospectively with GE Lightspeed Qx/I plus 16-slice helical CT perfusion imaging, and 25 patients with lung cancer were comparative studied with its MVD calculated using LSAB. With the CT perfusion 2-body tumor software, the parameters of CT perfusion including blood value (BV), blood flow (BF), mean transit time (MTT) and permeability surface (PS) were analyzed. Results: The four param- eter values in lung cancer were all higher than that in pulmonary benign masses, and there were significant differences among BV, MTT and PS (P<0.05), especially in BV (P<0.01). The MVD value of lung cancer was higher than that of pulmonary benign masses (P<0.05), and the MVD of adenocarcinoma was higher than that of squamous cell carcinoma (P<0.05). In 25 cases with lung cancer, there was positive correlation only between BV and MVD value (r=0.852, P<0.01). Conclusion: It is helpful to diagnose the peripheral lung cancer with MSCT perfusion imaging and to differentiate from pulmonary benign masses, its bases are MVD pathologically.
文摘目的探究多层螺旋CT低剂量扫描在肺部小结节鉴别诊断中的应用价值。方法选取2016年2月~2018年10月我院收治的100例肺部小结节患者,所有患者均行多层螺旋CT低剂量扫描,分析多层螺旋CT低剂量扫描的灵敏度、特异度及准确度、对比良、恶性结节影像学特征及不同病变类型的CT值。结果多层螺旋CT低剂量扫描在诊断肺部小结节中灵敏度为92.86%、特异度为88.64%、准确度为91.00%;相较于恶性结节,良性结节边缘清晰度、内部钙化检出率较高,边缘分叶状或不规则状、毛刺征,内部结构均匀检出率较低,差异有统计学意义(P<0.05);卫星灶在良性与恶性结节中的检出率比较,差异无统计学意义(P>0.05);良性结节30 s、90 s及180 s CT值均小于恶性结节,差异有统计学意义(P<0.05)。结论多层螺旋CT低剂量扫描在肺部小结节鉴别中具有较高的应用价值,可有效鉴别结节性质,且检查中辐射剂量较低,应用安全性高。
基金supported by CAMS Innovation Fund for Medical Sciences(2017-I2M-1-009)PUMC Youth Fund and the Fundamental Research Funds for the Central Universities(2017310049).
文摘Following publication of the results of the National Lung Screening Trial in the United States,a randomized controlled trial in Italy(ITALUNG)and two simulation studies in China reported similar findings in 2017 favoring lung cancer screening with low-dose computed tomography among smokers.With such advances in lung cancer screening,worldwide interest has gradually shifted from evaluating whether refining lung cancer screening protocols is effective in preventing deaths.However,there are several practical problems to be resolved,including the balance of enroll-ment criteria and cost effectiveness,precise measurements to reduce false positive findings,risk-based optimization of screening frequency,challenges associated with cancer heterogeneity,strategies to combine image screening with novel biomarkers,dynamic monitoring of the natural history of cancer,accurate identification and diagnosis of cases among huge populations,and the impact of tobacco control policy and environment protection.As one in three individuals with lung cancer worldwide resides in China,these questions pose great challenges as well as research opportunities for population screening programs in China.
