肺癌筛查的述评:肺癌筛查的风险

Natthaya Triphuridet, David F. Yankelevitz, Andrea Wolf
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摘要

低剂量胸部计算机断层扫描(LDCT)筛查肺癌高危人群是目前美国和欧洲国家的标准护理。LDCT已被证明可以降低肺癌死亡率。然而,应该关注肺癌筛查的潜在“副作用”和“风险”,并权衡其益处。总结LDCT进行肺癌筛查的风险。通常认为,LDCT筛查的潜在风险被降低高危人群肺癌死亡风险的益处所抵消。关于LDCT筛查危害的研究在阳性检测的定义和研究方案上存在差异。然而,使用当前的结节协议指南,根据一致性、大小和筛查轮来定义阳性结节,并采用特定的管理方案,如Lung-RADS,将减少基线和后续轮次的假阳性率,防止侵入性手术和假阳性检查相关的并发症,并降低过度诊断率。目前,没有流行病学证据支持LDCT筛查肺癌的辐射剂量低于100毫西弗会增加癌症发病率或死亡率。虽然在符合筛查条件的人群中,降低肺癌死亡风险的好处通常被认为超过了风险,但了解这些潜在风险很重要,特别是考虑到共同决策的要求。
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A narrative review of lung cancer screening: risks of lung cancer screening
: Low-dose chest computed tomography (LDCT) screening for lung cancer in high-risk individuals is the current standard of care in the United States and European countries. LDCT has been shown to reduce lung cancer mortality. However, potential “side effects” and “risks” of lung cancer screening should be concerned and weighed against its benefits. To provide a summary of the risk of lung cancer screening as performed with LDCT. The potential risks of LDCT screening are generally considered to be outweighed by the benefit of reducing the risk of lung cancer death in the high-risk population. The studies on harm of LDCT screening varied on definition of positive test and study protocol. However, using current nodule protocols guidelines defining positive nodule based on consistency, size, and round of screening with certain management protocol as Lung-RADS would have reduced in the false positive rate in baseline and subsequent rounds, prevented invasive procedures and complications associated with false positive exams and decreased the overdiagnosis rate. Currently, there are no epidemiological evidence supporting increased cancer incidence or mortality from radiation dose of the LDCT screening for lung cancer which below 100 mSv. While the risks are generally considered to be outweighed by the benefit of reducing the risk of lung cancer death in the screening-eligible population, it is important to understand these potential risks, especially given the requirements for shared decision making.
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