用低剂量计算机断层扫描检查肺癌:美国预防服务工作组的最新证据报告和系统审查
Daniel E Jonas1,2, Daniel S Reuland3,4,5, Shivani M Reddy1,6
1RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center.
JAMA
|March 9, 2021
概括
低剂量计算机断层扫描 (LDCT) 查可以减少高风险个体的肺癌死亡. 然而,它带有错误阳性,过度诊断和辐射暴露等风险, 需要仔细考虑益处与危害.
科学领域:
- 肺病学
- 放射学
- 预防医学
背景情况:
- 肺癌是美国癌症死亡的主要原因.
- 对美国预防服务工作组 (USPSTF) 关于肺癌查的建议进行证据审查.
研究的目的:
- 审查低剂量计算机断层扫描 (LDCT) 查肺癌的证据.
- 提供有关肺癌查的指导方针.
主要方法:
- 从2019年5月起对MEDLINE,Cochrane图书馆和试验登记处的英语研究进行系统审查,并通过2020年11月进行文献监测.
- 包括LDCT查,准确性,风险预测模型和早期肺癌治疗的研究.
- 对摘要,全文文章和研究质量进行质量综合的双重审查;由于异质性,数据没有被汇总.
主要成果:
- 七个随机临床试验 (RCT) 涉及86,486名参与者进行了LDCT查.
- 全国肺部查试验 (NLST) 显示,在55-74岁高危人群中,使用LDCT查可以减少肺癌死亡率 (IRR为0.85).
- 在50至74岁高危人群中,Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) 试验显示肺癌死亡率降低 (IRR为0.75).
结论:
- 在高危人群中,LDCT查可降低肺癌死亡率.
- 查存在风险,包括假阳性结果,不必要的手术,过度诊断和辐射暴露.
- 目前的结节评估方案可能会减轻一些危害,但需要进一步研究.
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