作者: Nanda Horeweg , Joost van Rosmalen , Marjolein A Heuvelmans , Carlijn M van der Aalst , Rozemarijn Vliegenthart
DOI: 10.1016/S1470-2045(14)70389-4
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摘要: Summary Background The main challenge in CT screening for lung cancer is the high prevalence of pulmonary nodules and relatively low incidence cancer. Management protocols use thresholds nodule size growth rate to determine which require additional diagnostic procedures, but these should be based on individuals' probabilities developing In this prespecified analysis, using data from NELSON trial, we aimed quantify how diameter, volume, volume doubling time affect probability within 2 years a scan, propose evaluate management protocols. Methods Eligible participants trial were those aged 50–75 years, who have smoked 15 cigarettes or more per day than 25 ten 30 still smoking, had stopped smoking less 10 ago. Participants randomly assigned low-dose at increasing intervals, no screening. We included all group attended least one round screening, whose results available national registry database. calculated probabilities, stratified by did logistic regression analysis time, multinodularity as potential predictor variables. assessed strategies threshold characteristics specificity sensitivity, compared them American College Chest Physicians (ACCP) guidelines. registered www.trialregister.nl, number ISRCTN63545820. Findings Volume, volumetry-based diameter 9681 non-calcified detected 7155 used probability. Lung was with 100 mm 3 smaller (0·6% [95% CI 0·4–0·8]) maximum transverse 5 (0·4% [0·2–0·7]), not significantly different without [0·3–0·6], p=0·17 p=1·00, respectively). intermediate (requiring follow-up CT) if 100–300 (2·4% 1·7–3·5]) 5–10 (1·3% [1·0–1·8]). Volume further probabilities: 0·8% (95% 0·4–1·7) times 600 days more, 4·0% (1·8–8·3) 400–600 days, 9·9% (6·9–14·1) 400 fewer. volumes 300 bigger (16·9% 14·1–20·0]) diameters (15·2% [12·7–18·1]). simulated ACCP protocol yielded sensitivity 90·9% 81·2–96·1), 87·2% (86·4–87·9), respectively. A diameter-based higher (92·4% 83·1–97·1]), (90·0% [89·3–90·7). volume-based (with probability) same (90·9% 81·2–96·1]), (94·9% [94·4–95·4]). Interpretation Small (those ≥10 mm). assessment advocated only intermediate-sized ranging between Nodule performed better protocol. Funding Zorgonderzoek Nederland Medische Wetenschappen Koningin Wilhelmina Fonds.