低剂量CT对肺癌早期筛查的研究

目的研究在肺癌高危人群中低剂量CT(LDCT)对肺癌早期诊断的可行性。方法 1019例受试者随机分入LDCT组(411例)和胸片(CXR)组(608例)。结果 LDCT组与CXR组分别有55例(13.4%)和13例(2.1%)非钙化结节,LDCT组有4例确诊为肺癌(3例Ⅰ期,1例Ⅲ期),CXR组2例(均为Ⅲ期)确诊为肺癌。结论 LDCT比CXR筛选阳性率高,更有利于发现早期肺癌。     

周围型肺癌早期影像诊断方法研究

在我国,肺癌的发病率呈逐渐增高趋势,中国预防科学院公布,在今后30年肺癌将成为中国居民的主要死因,因此肺癌的早期诊断依然是胸部影像检查的重点和难点。中央型肺癌的早期诊断由CT检查漏诊病例较常见。临床诊断主要依赖于支气管镜及痰细胞学检查。本仅针对周围型肺癌的早期影像诊断方法加以详述。     

肺癌筛查和早期诊断进展

随着工业发展、环境污染、吸烟人群增加,肺癌已成为国内大城市（如北京、上海）及西方工业国家恶性肿瘤发病率及死亡率的首位,已引起广泛重视。死亡率居高不下的原因是80％肺癌患就诊时已属晚期,治疗效果差,目前肺癌年平均存活率仅12％左右而Ⅰ期肺癌手术后5年存活率达70％,表明早期诊断、及时治疗是解决目前肺癌高死亡率的关键。随着诊断技术发展及对肺癌发生分子机制的了解,肺癌早期诊断手段增多,利用这些新技术提高早期诊断的准确性。[第一段]     

早期肺癌DR与低剂量螺旋CT影像特点分析

目的分析早期肺癌在数字化摄片机(DR)与低剂量螺旋CT(LDCT)中的影像特点,为早期肺癌的正确诊断提供帮助。方法回顾经病理确诊的53例早期肺癌患者的DR与LDCT影像表现并进行分析。结果中央型肺癌DR表现为肺门阴影增大增浓,结节状密度增高阴影等;早期周围型肺癌为圆形、椭圆形密度增高阴影,边缘毛刺、分叶症。LDCT中央型肺癌表现为支气管狭窄,支气管梗阻或气管壁增厚,阻塞性肺部改变,肺门结节;周围型肺癌表现为肺野内的孤立小结节、小斑片状阴影;可见征象分叶征81%、毛刺征65%、胸膜凹陷征53%、血管集束征38%、磨玻璃样征16%等。本组53例中,DR阳性率为33%,LDCT阳性率为90%,两组数据比较差异有统计学意义(χ2=8.63,P0.01)。结论低剂量螺旋(LDCT)对早期肺癌的征象及阳性率要明显优于DR,对早期肺癌的诊断、定性有着较大的价值。     

肺癌早期诊断进展

近20来年肺癌的治疗有了很大进展,但肺癌病人的预后却无明显提高,5年生存率仅10%～15%。其主要原因在于肺癌早期诊断率仅15%,常规筛查程序不够充分,未能识别支气管癌变的早期损害。肺癌的预后与诊断时的临床分期密切相关：0期肺癌病人术后5年生存率可达90%以上,Ⅰ期为60%,Ⅱ～Ⅳ期病人则从40%下降至5%以下。     

CT动态增强扫描应用于早期肺癌诊断的价值

目的 探究CT动态增强扫描应用于早期肺癌诊断的价值.方法 纳入46例早期肺癌患者进行实验观察,研究时间开始于2017年11月,结束于2019年11月.采用随机分组法对患者进行分组处理,其中23例患者纳入对照组,接受胸部X片诊断;另外23例患者纳入观察组,使用16排螺旋CT诊断,观察对比两组患者诊断结果 ,并进行CT影像学特征分析.结果 观察组患者诊出病情的有22例,其中0例误诊,1例漏诊,诊断准确率95.7%,对照组中17例诊出病情,2例误诊,4例漏诊,诊断准确率73.9%,两组间比较的差异显著(P<0.05).进一步进行CT影像学分析,根据观察,观察组中,病灶位于左肺13例,右肺10例,孤立结节影15例,不规则片状影8例;病灶结构:空泡征5例,细支气管征8例,毛玻璃病灶2例,病灶内有空洞3例,病灶有钙化5例.根据CT增强扫描的结果 ,观察组23例患者中,CT值呈现均匀强化的情况,增强值最高可达40 HU.结论 运用CT的增强动态扫描来对早期的肺癌患者进行诊断分析,可以大幅度提升诊断结果 的准确率,及时了解患者病情变化,对后续治疗工作的开展十分有利,可以在临床应用上大力推广.     

肺癌早期诊断进展

肺癌已成为世界各国发病率及死亡率的首位 ,80 %肺癌患者就诊时已属晚期 ,治疗效果差 ,肺癌年平均存活率仅 12 %左右 ,而 期肺癌手术后 5年存活率达 70 % [1 ] ,表明早期诊断的重要性。1　影像手段1.1　低剂量螺旋 CT(Helical low radiation dose computer to-mography) :是指采用螺旋 CT扫描时 ,设定电压为 14 0 Kvp,电流 4 0 m A,螺距 10 mm,呼气末 15 - 2 0秒内一次扫描完成。扫描后图像经高分辨骨算法重叠 5 mm重建 ,仅提供肺窗片 (窗宽15 0 0 ,窗位 6 5 0 )。由于电流减少 ,辐射量降低 ,减少能耗、降低成本及增加 X线球管寿命 ,减…     

肺部弥漫性病变中肺癌和肺结核的CT影像鉴别

肺部弥漫性病变是指病变累及双肺全部或几乎全部，并在胸片或CT上形成各种影像表现的肺部疾病的统称，是一种非特异性术语。肺部弥漫性病变病种繁多，而且许多疾病的临床症状及体征较为相似，其胸片表现、CT征象也大同小异，给诊断和鉴别诊断带来极大困难，所以肺部弥漫性病变的诊断一直是临床值得深入研究的课题。随着CT特别是多层螺旋CT高分辨扫描（HRCT）的广泛应用，可以较清楚地显示肺小叶的细微结构，为肺部弥漫性病变的诊断和鉴别诊断提供了更为详尽的影像信息，是诊断肺部弥漫性病变的首选方法。     

肺癌早期诊断方法研究进展

目前肺癌在世界范围内居癌症病死率首位,由于早期常无特殊临床表现,80％的肺癌患者就诊时已属中晚期、治疗效果差,而早期肺癌（IA期）的5a生存率超过70％。现将近年来肺癌的早期诊断方法研究进展综述如下,旨在为及早诊治肺癌提供依据。     

体定向放射治疗早期非小细胞肺癌(附36例报告)

对 36例临床 ～ 期非小细胞肺癌患者行立体定向放射治疗 ,病灶 <3cm者采用弧形照射 ,剂量 10～15 Gy/次 ,共 3～ 5次 ;>3cm者采用非共面适形野 ,剂量 5～ 8Gy/次 ,共 6～ 12次。结果 :近期完全缓解 ( CR)率为 5 3% ,部分缓解 ( PR)率为 36 % ,总有效率 ( CR PR)为 89%。肿瘤直径 <3cm者 CR率为 76 .5 % ,>3cm者为 31.5 % ,差异有显著意义 ( P <0 .0 5 ) ;其 1、 2年生存率分别为 83.3%、 5 2 .4 % ; 期、 期 1年生存率分别为 96 %、 5 4 .5 % ,差异有显著意义 ( P <0 .0 1)。放射性肺反应早期多为 0级 ,晚期肺反应多为 1级。说明立体定向放射治疗技术治疗早期非小细胞肺癌是安全、有效的 ,近期疗效满意 ,远期疗效有待进一步观察     

Population-based study of DNA image cytometry as screening method for esophageal cancer

AIM: To explore the DNA image cytometry (DNA-ICM) technique as a primary screening method for esophageal squamous precancerous lesions.METHODS: This study was designed as a population-based screening study. A total of 582 local residents aged 40 years-69 years were recruited from Linzhou in Henan and Feicheng in Shandong. However, only 452 subjects had results of liquid-based cytology, DNA-ICM and pathology. The sensitivity and specificity of DNA-ICM were calculated and compared with liquid-based cytology in moderate dysplasia or worse.RESULTS: Sensitivities of DNA-ICM ranging from at least 1 to 4 aneuploid cells were 90.91%, 86.36%, 79.55% and 77.27%, respectively, which were better than that of liquid-based cytology (75%). Specificities of DNA-ICM were 70.83%, 84.07%, 92.65% and 96.81%, but the specificity of liquid-based cytology was 91.91%. The sensitivity and specificity of a combination of liquid-based cytology and DNA-ICM were 84.09% and 85.78%, respectively.CONCLUSION: It is possible to use DNA-ICM technique as a primary screening method for esophageal squamous precancerous lesions.     

Factors determining early adherence to a lung cancer screening protocol.

Lung cancer screening using computed tomography (CT) is effective in detecting early stage disease. However, concerns regarding adherence have been raised. The current authors conducted a retrospective observational study of 641 asymptomatic smokers enrolled in a lung cancer screening programme between 2000 and 2003. Adherent subjects were compared with nonadherent subjects with regard to lung function, sex, age, motivation for enrollment, smoking status, distance to the referral centre, family history of lung cancer, asbestos exposure, education, the presence and type of nodule(s) seen on initial CT, and exposure to a nursing intervention designed to improve adherence. Overall, early adherence to the study protocol was 65%. Multivariate analysis confirmed the importance of sex, proximity to the referral centre, the presence of noncalcified nodules, and the nursing intervention as factors conditioning adherence to the study protocol. Patients encouraged to participate in the study were more adherent, as were former smokers. Sex interactions were observed in multivariate analysis. The nursing intervention was significant for females, while abnormal lung function improved male adherence. Adherence to lung cancer screening is particularly good among females and subjects living near the referral centre. The present study suggests the need to develop new strategies, especially those targeting males and subjects with low risk perception, in order to improve adherence.     

Proteomics as a method for early detection of cancer: a review of proteomics, exhaled breath condensate, and lung cancer screening

The study of expressed proteins in neoplasia is undergoing a revolution with the advent of proteomic analysis. Unlike genomic studies where individual changes may have no functional significance, protein expression is closely aligned with cellular activity. This perspective will review proteomics as a method of detecting markers of neoplasia with a particular emphasis on lung cancer and the potential to sample the lung by exhaled breath condensate (EBC). EBC collection is a simple, new, and noninvasive technique, which allows sampling of lower respiratory tract fluid. EBC enables the study of a wide variety of biological markers from low molecular weight mediators to macromolecules, such as proteins, in a range of pulmonary diseases. EBC may be applied to the detection of lung cancer where it could be a tool in early diagnosis. This perspective will explore the potential of applying proteomics to the EBC from lung cancer patients as an example of detecting potential biomarkers of disease and progression.     

老年肺癌患者发生骨转移的临床特征及早期筛查策略

目的探讨老年肺癌骨转移患者的临床特征及危险因素。方法本研究为病例对照研究, 采用非随机抽样的方法纳入2015年1月至2020年12月于河北医科大学第三医院初诊的老年肺癌患者205例, 分为骨转移组111例, 未转移组94例, 比较2组的基础资料、血生化和肿瘤标志物, 记录骨转移组骨折部位, 比较不同病理类型肺癌组骨相关事件的发生率。采用多因素logistic回归分析影响肺癌患者骨转移的危险因素。结果 205例老年肺癌患者中骨转移111例, 其中腺癌、鳞癌、小细胞肺癌及其他病理类型分别占68.47%(76/111)、13.51%(15/111)、15.32%(17/111)、2.70%(3/111)。最常见的转移部位依次是脊柱、肋骨、骨盆、四肢长骨、肩胛骨、胸骨、颅骨。单发骨转移灶占22.52%(25/111), 2个骨转移灶36.04%(40/111), 多个(≥3个)骨转移灶占41.44%(46/111)。发生骨相关事件58例(52.25%)。骨转移组与未转移组神经元特异性烯醇化酶(NSE)、癌胚抗原(CEA)、凝血酶原活动度、碱性磷酸酶(ALP)、纤维蛋白原、纤维蛋白降解产物(FDP)、D-二聚体比较差异均有统计学意义(P值均<0.05);多因素logistic回归分析结果显示ALP、NSF、CEA、FDP是影响肺癌患者骨转移的独立危险因素。结论脊柱是最常见骨转移部位。ALP、NSE、CEA、FDP是影响肺癌骨转移的独立危险因素。     

The effect of surgical treatment on survival from early lung cancer. Implications for screening.

We assessed the effect of surgery on survival from stage I non-small-cell lung cancer based on data collected in these screening programs. The majority of patients diagnosed in each program were treated by surgical resection, but 5 percent of the Sloan-Kettering group, 21 percent of the Hopkins group and 11 percent of the Mayo group failed to receive surgical treatment. Approximately 70 percent of the stage I patients in each program who were treated surgically survived more than five years, but there were only two five-year survivors among those who did not have surgery. We conclude that patients with lung cancers detected in stage I by chest x-ray film and treated surgically have a good chance of remaining free of disease for many years. Those stage I lung cancers which are not resected progress and lead to death within five years. Therefore, every effort should be made to detect and treat lung cancer early in high-risk populations.     

Computed tomography screening for lung cancer

The development of CT technology reopened the lung cancer screening debate. Computed tomography screening for lung cancer certainly meets all the criteria required for an appropriate screening test. First and perhaps most importantly, the disease for which the screening is being performed should have a significant prevalence in the population being studied and be a significant health risk for those afflicted with it. Lung cancer is the leading cause of cancer death in both men and women, and one of the most lethal of all cancers.     

Update on screening for lung cancer

Prognosis of lung cancer is markedly improved when cancers are resected in early stages (particularly in stage I). Previous investigations failed to show benefit with use of chest radiographs or sputum cytologies to screen for lung cancer among high-risk populations. More recently, computed tomography (CT) has been used as a screening technique and appears to detect lung cancer at earlier stages (e.g., stage I) compared with usual clinical practice. However, whether screening CT reduces death from lung cancer has not been clarified. This review examines the problem presented by lung cancer, the issues presented by screening, and the results of past and recent studies of lung cancer screening.     

肿瘤相关自身抗体在肺癌筛查和早期诊断领域的研究进展

当前,肺癌筛查和早期诊断领域还存在许多问题,临床亟需特异度高、敏感度好、无创并且方便易行的方法来提高肺癌筛查和早期诊断的效率。近年来的研究显示,肿瘤相关自身抗体联合检测实验在肺癌筛查和早期诊断领域显示出良好的特异度和较好的敏感度。而且,它与低剂量CT联合使用可降低CT的假阳性率、提高特异度和阳性预测值,有助于肺癌的早期发现和早期诊断。本文将对肿瘤相关自身抗体的产生机制和特点、对肺癌尤其是早期肺癌的诊断效能、在肺癌筛查和早期诊断领域面临的问题等进行综述。