肺癌早筛早诊的精准化探索

目前,肺癌仍是全世界范围内癌症相关死亡的主要原因.早期肺癌可以实现治愈,而晚期肺癌患者的5年生存率极低,因此早诊早治是提高生存率的关键.既往研究已经证实了运用低剂量CT对肺癌高危人群进行筛查可降低肺癌相关死亡率,但肺癌早期诊治策略仍有许多问题亟需解决,如高危人群的选择和肺结节良恶性的鉴别判断尚欠精准.本研究总结近年来本...     

肺癌筛查和早期诊断研究进展

在我国肺癌已居肿瘤相关死亡的首位,虽然进展期肺癌患者预后很差,但大部分早期肺癌是可以治愈的.早期诊断、外科治疗仍是提高肺癌治愈率的主要手段.本文复习有关胸片(CXR)、痰细胞学、荧光纤支镜、低剂量CT(LDCT)以及分子生物学技术等在肺癌筛查和早期诊断中应用的相关文献,并对它们的效果加以评估.LDCT是目前对高危人群筛查最有效的方法,荧光纤支镜、痰液基细胞学、分子生物学技术的进展则对早期诊断有重要作用.     

低剂量CT筛查肺癌之现状和展望

肺癌高居全球癌症死亡的首位.遗憾的是,因出现症状而就诊的肺癌多属晚期,预后甚差.肺癌筛查的想法可追溯到上世纪五十年代,摄胸片筛查了6000名男性志愿者,虽生存期较有症状组稍有延长,但死亡率无明显差异.随着低剂量CT检查技术的开展,于上世纪九十年代中、晚期报道,用低剂量CT筛查有较高的早期肺癌检出率.使肺癌筛查重又燃起希望.但因这些筛查试验缺乏对照组,故不足以确定低剂量CT筛查是否能降低肺癌死亡率.文献中对仍有很多争论.为确定CT筛查是否真正有益,美国全国肺癌筛查试验及NELSON试验进行之中.预计2010年可得出最终结果.肺癌筛查是一复杂的有争议的问题,通过CT筛查是否能实质性地降低肺癌死亡率,仍不清楚.尽管CT筛查充满希望,但仍存在一些问题有待解决,在采取大面积筛查前须对其有所了解.     

肺癌早期筛查研究进展

Ⅰ期与Ⅲ-Ⅳ期肺癌预后差别极大,其治疗及预后的关键在于早期诊断,早期肺癌的筛查早已成为全世界研究的热点.本文就目前肺癌筛查的必要性、可行性、人群选择,特别是技术方案做一综述.     

北京市城区肺癌高危人群低剂量螺旋CT筛查依从性及其影响因素分析

摘 要：［目的］ 分析2014—2019年北京市城区肺癌高危人群低剂量螺旋CT（LDCT）筛查依从性及其影响因素。［方法］ 采用整群抽样方法,选取来自北京市东城、西城、朝阳、海淀、丰台和石景山共6个城区癌症早诊早治项目点的40~69岁北京市户籍居民进行问卷调查以评估癌症风险,对评估出的肺癌高危人群开展LDCT筛查。采用χ２检验比较不同特征人群的LDCT筛查参与率（依从性）差异,采用多因素非条件Logistic回归模型分析其影响因素。［结果］ 共88 044名北京市城区居民参与调查,其中20 371人被评估为肺癌高危人群,高危率为23.1%。有10 645人接受了LDCT筛查,总体参与率为52.3%。多因素Logistic回归分析显示,女性、50岁及以上年龄组、大学/大专及以上学历、存在有害职业暴露、家庭做饭时油烟较多、有被动吸烟史、自报存在精神创伤或压抑的人群LDCT筛查依从性更好,目前正在吸烟的人群依从性较差。［结论］ 北京市城区肺癌高危人群的LDCT筛查依从性仍有提升空间。未来应针对不同特征人群实施更加精准的健康教育和管理策略,进一步提高肺癌高危人群的LDCT筛查依从性。     

职业高危人群肺癌病例胸部X线片和痰细胞学筛查结果分析

背景与目的 肺癌已成为中国癌症死亡的首位死因，以人群为基础的肺癌筛查的效果评价目前仍存在争议。本研究的目的是分析胸部X线片和痰细胞学筛查在职业高危人群肺癌早期检出中的作用。方法 对1992～1999年云锡矿工肺癌筛查队列的筛查结果进行回顾性分析。结果 共有9317名矿工参加了筛查，进行了46779次胸部X线片检查，45672次痰细胞学检查，793名队列成员至少有一次阳性结果，历年的阳性率为1214．1／100000～3482．7／100000。随访至2001年底，共433例肺癌发病，其中371例获得细胞／病理学结果，以鳞癌居多（55.0％），其次为腺癌和小细胞癌，Ⅰ，Ⅱ期肺癌占24．0％。62．1％的肺癌患者至少有一次阳性结果，胸部X线片单独检出165例，痰细胞学单独检出56例，两种方法联合检出48例，胸部X线片检出的肺癌以鳞癌腺癌居多（64．2％），痰细胞学检出的绝大多数为鳞癌（75.0％），有阳性筛查结果历史的早期肺癌占早期肺癌的80．8％。结论 本研究表明每年一次的胸部X线片联合痰细胞学肺癌筛查对职业高危人群肺癌的早期检出具有一定意义，可为我国高危人群肺癌的筛查提供一定的借鉴依据。     

肺癌早期筛查研究进展

Ⅰ期与Ⅲ-Ⅳ期肺癌预后差别极大,其治疗及预后的关键在于早期诊断,早期肺癌的筛查早已成为全世界研究的热点。本文就目前肺癌筛查的必要性、可行性、人群选择,特别是技术方案做一综述。     

疫情防控常态下肺癌早筛的现状及进展

肺癌是我国发病率最高的恶性肿瘤。早发现早鉴别出有症状的肺癌患者和及时从高危人群中筛选出无症状患者需要多方面配合。目前,尽管已经联合影像学、血清学、基因组学、蛋白质组学等手段对可疑肺癌进行筛查,但仍存在漏诊、误诊等问题。同时,新型冠状病毒肺炎(corona virus disease 2019, COVID-19)流行病的蔓延给肺癌早筛带来了新的挑战。在疫情防控常态化下,肺癌早筛工作应该做出相应改变:提高人群防癌控癌意识、加强就诊流程管理、提高肿瘤检出效率、优化检测技术并合理利用互联网和大数据平台。联合多种筛查方法建立一种理想的肺癌早筛模式,保证疫情防控常态下肺癌早筛工作既精简又高效。     

2014-2016年合肥市城市居民肺癌筛查率及筛查结果分析

目的 分析2014—2016年合肥市城市居民肺癌筛查率及筛查结果,评价肺癌筛查效果.方法 采取整群抽样的方法,对合肥市7个区40～69岁常住居民进行癌症危险因素问卷调查和肺癌高危因素评估,对评估出的肺癌高危人群进行胸部低剂量螺旋CT检查.分析肺癌高危人群筛查率和检出率.采用主动随访加被动随访统计确诊肺癌数,计算肺癌发病...     

乌鲁木齐市社区肺癌高危人群低剂量螺旋CT筛查结果分析

[目的]对乌鲁木齐市城市社区40～69岁人群开展肺癌筛查,评价筛查效果.[方法]对问卷评估的11 512名肺癌高危人群低剂量螺旋CT检查.[结果]共完成肺癌CT筛查3436人,依从性为20.4％.共发现1294人有肺内结节(37.6％),367人有阳性结节(10.7％),可疑肺癌16例(0.46％).男性阳性结节的检出率高于女性.60～69岁年龄组在阳性结节、小结节、可疑肺癌的检出率都高于其他年龄组.[结论]低剂量螺旋CT适合肺癌的高危人群筛查,有助于早期发现肺内的阳性结节和相关疾病,60岁以上人群肺癌的筛查应该引起高度重视.     

肺癌的早期诊断

肺癌已成为人类癌症死亡的主要原因之一,5年生存率仅10％。既往应用胸部X线和痰细胞学进行筛查和早期诊断的研究没有达到诊断筛查的目的－－肺癌死亡率的下降。随着新技术的发展,人们对肺癌筛查重新产生了兴趣。本文回顾了肺癌早期诊断最新进展,有低剂量CT、液基细胞学技术、荧光内镜和分子病理学等方面。     

肺癌流行病学和早期诊断新技术

肺癌是当今世界各国常见的恶性肿瘤 ,并已成为癌症死亡的主要原因。 2 0 0 0年美国新发病例达 16 94万人 ,近年来通过采用控制吸烟及大气污染等措施 ,发达国家的肺癌发病率有所下降 ,但我国肺癌发病率及死亡率仍占据首位。原发性肺癌的早期诊断非常重要 ,临床诊疗技术和先进仪器的使用有助于早期发现肺癌。就低剂量螺旋CT、荧光支气管镜、CT PET等在肺癌早期诊断中的应用及进展。     

Molecular sputum analysis for the diagnosis of lung cancer

Lung cancer is the leading cause of cancer mortality rate worldwide, mainly because of the presence of metastatic disease at the time of diagnosis. Early detection of lung cancer improves prognosis, and towards this end, large screening trials in high-risk individuals have been conducted since the past century. Despite all efforts, the need for novel (complementary) lung cancer diagnostic and screening methods still exists. In this review, we focus on the assessment of lung cancer-related biomarkers in sputum in the past decennium. Besides cytology, mutation and microRNA analysis, special attention has been paid to DNA promoter hypermethylation, of which all available literature is summarised without time restriction. A model is proposed to aid in the distinction between diagnostic and risk markers. Research on the use of sputum for non-invasive detection of early-stage lung cancer has brought new insights and advanced molecular techniques. The sputum shows a promising potential for routine diagnostic and possibly screening purposes.     

Lung cancer screening-its present situation, problems and perspectives

Mortality from lung cancer is increasing at the rate of more than 7% annually, becoming 31.7 per 100,000 among males in 1983. Out of 3,278 cities, towns and villages all over Japan, 21% of them were carrying out mass screening programs for lung cancer in 1982, and many other municipalities have followed suit over the last few years. Lung cancer screening has spread because of the widespread use of mass miniature radiophotography (MMR) for tuberculosis which has been adopted for use for lung cancer on the one hand, and because many research programs have revealed rather high detection rats with excellent prognosis for occult lung cancer using sputum cytology on the other. As screening procedures differ from one area to another, evaluation of the various methods of screening has been made. Emphasis is laid on the importance of double reading of X-ray film, comparisons of X-ray findings with those of previous one, criteria of screening for doubtful lung cancer cases, criteria for high-risk groups in sputum cytology, and so on. Epidemiological effects of lung cancer screening have not yet been confirmed, but so many lung cancer cases have been detected and treated, that a realistic approach for the improvement of screening programs was discussed.     

肺癌早期诊断研究进展

肺癌是绝大多数国家主要的癌症死亡原因,早期诊断和早期治疗尤为重要.以胸部X光片、螺旋CT、支气管内镜、痰液细胞学等检测手段用于肺癌的筛检和早诊已有较多报道,但鉴于以上检查手段的敏感性、特异性、适用度等方面的局限,近年来国内外学者对有关肺癌早期诊断的分子标志物做了大量有益的探索,本文拟就该领域的相关进展作一综述.     

肺癌筛查方法现状

肺癌是目前恶性肿瘤死亡的首要原因,早期诊断对肺癌的预后至关重要。研究显示低剂量计算机断层扫描（computed tomography, CT）筛查可以使肺癌的死亡率下降。但其存在的问题不可忽视,如过高的假阳性率、过度诊断、辐射效应等。作为一种肿瘤无创筛查方法,血液相关肿瘤标志物的检测,在肺癌早期诊断中显示出良好的敏感性和特异性。如何利用现有的筛查手段,建立肺癌筛查综合模式,需要更多大规模的临床研究。     

支气管镜介入技术在外周肺病变中的应用

肺癌是全球癌症相关死亡的主要原因,肺癌的治愈率很低,不仅因其自身攻击性,还因对肺癌筛查的忽视。随着肺部筛查手段的不断进展,肺外周病变的检出率逐渐提高,当前对外周肺病变进行诊断的最常用方法是经支气管行支气管镜检查或计算机断层扫描（computed tomography, CT）引导下经皮穿刺针吸/活检,然而对于外周肺病灶,支气管镜检查有较低的诊断率,经皮穿刺检查有较高的气胸发生率,因此,使用安全、微创的方法对外周肺病变进行组织确诊是临床工作者将面临的挑战。新型支气管镜介入诊断技术已逐渐用于临床,这些技术可有效提高外周肺病变的诊断率,缩短诊断时间,使患者获得及时有效的治疗。本文将现有的技术进行简要综述以帮助临床医生尝试应用这些微创技术。     

Development of Molecular Approaches to Early Lung Cancer Detection

Lung cancer has been particularly recalcitrant to standard therapeutic interventions. Improvement in the outcome for this disease requires the ability to identify the disease while it is still localized in the airways. Usually, radiation therapy to eliminate this disease fails because of progression of the cancer outside the radiation treatment ports. This is a failure of the diagnostic modalities to detect the extent of the cancer, not a failure of the radiation. With new epithelial-directed diagnostics, the ability to detect the premetastatic phase of lung cancer is emerging. Evolution of the screening infrastructure will be required to allow percolation of this technology out to the medical community, so that a benefit in cancer mortality reduction can be achieved. Some development issues will have to be resolved. Considering our fragmentary understanding of pulmonary carcinogenesis, the heterogeneity of lung cancer suggests that a panel of biomarkers instead of a single marker will be required to clarify the status of an individual's epithelium. However, the data output from multiplexed bioassays performed on large clinical populations will require better integration of information technology to optimize analysis and reporting of test results. An important new area for outcomes research is the systematic analysis of population screening approaches. With population sampling algorithms, selective screening. This type of research requires careful clinical validation. Finally, the general acceptance of population-based screening will be determined by the availability of effective interventions to complement the new diagnostic tools. New measures to prevent the progression of early cancer will be discussed.     

Screening for lung cancer

PURPOSE OF REVIEW: With the development of newer forms of technology such as low-dose spiral computed tomography, there has been a resurgent interest in screening for lung cancer. The purpose of this review is to highlight recent advances in screening for lung cancer. Articles published since September 2002 are reviewed here. RECENT FINDINGS: More frequent screenings (every 4 or 6 months) showed increased mortality from lung cancer, compared with annual screening. A mass screening conducted in 1990 was effective in a case-control study. The results of lung cancer screening by low-dose spiral computed tomography were reported from the Milan group and the Mayo Clinic. Computed tomography depicted peripheral early lung cancer, especially adenocarcinoma. These results are consistent with previous reports from other groups. Screening with imaging becomes more sensitive with automated computerized methods. SUMMARY: A high percentage of stage IA lung cancers were detected by screening with low-dose helical computed tomography. The characteristics of the nodules detected by low-dose spiral computed tomography have been clarified. There have been many controversial discussions about cost effectiveness and overdiagnosis. There is still no evidence that screening tests reduce the rate of cancer-specific mortality. Several studies of screening for lung cancer are under way.