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
Objective： To evaluate the role of spiral CT imaging postprocessing techniques in preoperative TNM staging of lung cancer. Methods： 106 patients with pathologically confirmed lung cancer received spiral CT examinati...Objective： To evaluate the role of spiral CT imaging postprocessing techniques in preoperative TNM staging of lung cancer. Methods： 106 patients with pathologically confirmed lung cancer received spiral CT examinations with a new revised TNM staging method of lung cancer which was taken as criterion of diagnosis. The images were reconstructed by using different postprocessing techniques such as MPR, MIP, SSD, VR, and their TNM staging capabilities were assessed by using postprocessing imaging and the results with axial CT images were compared. Results： In T staging, the accurate rates of axial CT images in T1-T4 staging were 77.3%, 60.6%, 60.7%, and 60.3% respectively; for postprocessing images, the accurate rates were 86.4%, 90.9%, 89.3%, and 87.0% respectively, In N staging, the accurate rates of axial CT images were 84.6%, 68.1%, 63.6%, and 64.2% in N0-N3 staging, respectively; but they were 92.3%, 90.9%, 90.9%, and 85.7% in postprocessing images, respectively. The postprocessing images were superior to axial CT images in T1-T3 and N1-N3 staging of lung cancer but there were no significant differences in T1 and NO staging. For metastasis, the postprocessing images may be helpful for the TNM staging of lung cancer. Conclusion： The postprocessing techniques of the spiral CT could improve the accurate rates of TNM staging of lung cancer, and represent a useful complement to the axial CT.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.
文摘Objective： To evaluate the role of spiral CT imaging postprocessing techniques in preoperative TNM staging of lung cancer. Methods： 106 patients with pathologically confirmed lung cancer received spiral CT examinations with a new revised TNM staging method of lung cancer which was taken as criterion of diagnosis. The images were reconstructed by using different postprocessing techniques such as MPR, MIP, SSD, VR, and their TNM staging capabilities were assessed by using postprocessing imaging and the results with axial CT images were compared. Results： In T staging, the accurate rates of axial CT images in T1-T4 staging were 77.3%, 60.6%, 60.7%, and 60.3% respectively; for postprocessing images, the accurate rates were 86.4%, 90.9%, 89.3%, and 87.0% respectively, In N staging, the accurate rates of axial CT images were 84.6%, 68.1%, 63.6%, and 64.2% in N0-N3 staging, respectively; but they were 92.3%, 90.9%, 90.9%, and 85.7% in postprocessing images, respectively. The postprocessing images were superior to axial CT images in T1-T3 and N1-N3 staging of lung cancer but there were no significant differences in T1 and NO staging. For metastasis, the postprocessing images may be helpful for the TNM staging of lung cancer. Conclusion： The postprocessing techniques of the spiral CT could improve the accurate rates of TNM staging of lung cancer, and represent a useful complement to the axial CT.
