低剂量螺旋CT在早期肺癌筛查中的应用价值

目的:探讨低剂量螺旋CT在早期肺癌筛查中的应用价值。方法:选择2016年5月至2017年10月在南充市中心医院接受低剂量螺旋CT肺癌筛查的吸烟人群2 100例作为研究对象,记录所有人群的影像学特征资料与一般人口学资料。结果:CT筛查出345例为阳性结节,占比16.4%,实性结节245例,非实性结节60例,部分实性结节40例。CT筛查出肺癌30例,占阳性结节的8.7%;经病理证实有27例肺癌患者,非实 性结节、部分实性结节中肺癌的比例高于实性结节,对比差异显著(P＜0.05);不同结节患者的直径对比无显著差异(P＞0.05)。在27例肺癌患者中,CT表现为边缘毛糙20例,光整7例;形态不规则22例,规则5例;胸膜凹陷12例,支气管充气征6例,空泡1例;临床分型:周围型23例,中央型4例。结论:低剂量螺旋CT在早期肺癌筛查中的应用有很好的价值,有利于肺结节的检出,有利于预防早期肺癌的进展。     

基于社区的早期肺癌低剂量螺旋CT扫描筛查上海实践初探

背景与目的：作为中国最常见的恶性肿瘤,肺癌的发病率及死亡率长期保持在较高水平。而有效改善肺癌预后,关键在于早期诊断和规范治疗。本研究密切结合上海社区医疗服务发展现状,整合各级医疗机构优势资源,探索基于上海社区的早期肺癌低剂量螺旋CT筛查路径模式。方法：2013年8月—2014年8月,针对上海市闵行区部分试点社区,以低剂量螺旋CT作为肺癌初步筛查手段,在高危人群中开展肺癌早期诊断,并结合以微创手术治疗为主的多学科综合治疗模式,构建涵盖肺癌预防、诊断、治疗、康复及随访等医疗服务措施的综合治疗立体网络。结果：筛查总人数为11332人(男性7144人,女性4188人)。其中,明确诊断恶性肿瘤29例,包括原发性肺癌27例、转移性肺癌1例和乳腺癌1例;筛查原发性肺癌发病率为238.26×10-5;0~Ⅰ期肺癌共22例,在原发性肺癌中占81.48%。结论：基于上海社区的早期肺癌低剂量螺旋CT筛查路径模式提高肺癌早期诊断率,具有可行性及有效性,可在有条件的社区及医疗卫生机构推广。     

低剂量螺旋CT扫描技术在早期肺癌中的诊断价值

目的 探讨低剂量螺旋CT扫描技术在早期肺癌中的诊断价值.方法 回顾性分析120例早期肺癌患者的临床资料,根据螺旋CT扫描剂量的不同将患者分为对照组和观察组,每组60例.对照组患者采用常规剂量螺旋CT扫描,观察组患者采用低剂量螺旋CT扫描.观察并比较两组患者的肺癌检出率、图像质量评分、结节检出情况及辐射剂量情况.结果 观察组患者的肺癌检出率为90.0％,对照组患者的肺癌检出率为91.7％,两组患者的肺癌检出率比较,差异无统计学意义(P>0.05).两组患者的图像质量合格率均为100％,但观察组患者的优质图像比例低于对照组患者,差异有统计学意义(P<0.05).观察组患者的图像噪声值为(63.9±11.5),高于对照组患者的(36.2±9.1),差异有统计学意义(P<0.05).两组患者的图像质量评分、病灶特征的扫描结果和肺癌结节检出数量、结节平均大小比较,差异均无统计学意义(P>0.05).观察组患者的加权CT剂量指数(CTDIw)、有效mAs、剂量长度乘积(DLP)和最大有效辐射剂量均明显低于对照组患者,差异均有统计学意义(P<0.01).结论 低剂量螺旋CT扫描可以明显减少早期肺癌患者接受的辐射剂量,安全性好,值得临床推广应用.     

肺癌低剂量螺旋CT筛查的研究进展

<正>肺癌是当前对人类威胁最大的恶性肿瘤。在全球范围内,其死亡率高居男性的首位,女性的第二位[1]。在我国及美国,其死亡率已稳居男、女性恶性肿瘤死亡率的首位[2,3]。美国2010年肺癌预期死亡病例占癌症总死亡人数的28%,超过前列腺癌、     

肺癌低剂量螺旋CT筛查应用现状及问题探讨

摘 要：肺癌是全球最常见的癌症死亡原因。早期肺癌检出率低是导致肺癌高死亡率的一大原因。肺癌低剂量螺旋CT（low-dose computed tomography,LDCT）筛查是目前全球公认的能够有效降低肺癌死亡率的方法。尽管LDCT已被证实在肺癌筛查中的作用,但其临床运用仍有许多问题亟需解决。全文对筛查人群的选择、肺结节管理流程的完善、肺癌预测因子的开发方面作一综述。     

低剂量螺旋CT对肺癌高危人群早期筛查的临床研究

目的 探讨低剂量螺旋CT对筛查早期肺癌的临床价值.方法 回顾性分析7052例肺癌高危人群分别接受DR胸片及低剂量螺旋CT肺部扫描的影像学资料.结果 7052例肺癌高危人群受检者经低剂量螺旋CT扫描,共筛查出肺结节共1527例,其中经病理确诊肺癌共96例,肺癌总体检出率为1.36%,高于DR的检出率(0.52%),差异具有统计学意义(P<0.05).结论 低剂量螺旋CT能够提高肺内非钙化结节的检出率,对早期诊断肺癌具有重要的临床价值.     

低剂量螺旋CT联合7种肺癌自身抗体检测对早期肺癌的筛查价值

目的 探讨低剂量螺旋CT联合7种肺癌自身抗体[p53、蛋白基因产物9.5(PGP9.5)、SOX区域Y相关HMG蛋白家族成员2(SOX2)、G抗原7(GAGE7)、RNA解旋酶自身抗体4-5(GBU4-5)、黑色素瘤抗原A1(MA-GEA1)、肿瘤相关基因(CAGE)]检测对早期肺癌的筛查价值.方法 对108例患者进行...     

低剂量螺旋CT肺癌筛查的研究现状与进展

肺癌是最常见的恶性肿瘤之一,严重影响人民身心健康。在全世界大多数国家,其发病率和死亡率均居首位,因此对肺癌高危人群进行早期筛查的必要性与日俱增。随着低剂量螺旋CT(Low-dose computed tomography,LDCT)在各个国家的推广和应用,肺癌的死亡率明显降低,但同时也带来许多问题,如假阳性过高、过度诊断会造成患者经济和心理的双重负担;女性被动吸烟的人数越来越多,但未被纳入肺癌高危人群的筛查;肺癌筛查对高危人群的定义与标准、阳性结节的定义与标准均尚无统一指南发布等。这些问题日益突出,是现今大多数研究面临的主要困难与挑战。本文就LDCT肺癌筛查的研究现状和进展做一综述。     

血清自身抗体联合低剂量螺旋CT在肺癌早期筛查中的价值

目的 探讨血清自身抗体检测联合低剂量螺旋CT（LDCT）在肺癌早期筛查中的可行性。方法 收集武汉大学人民医院体检中心体检人群12 568例体检资料,男7 453例、女5 115例,筛选出肺癌高危人群1 324例纳入本研究,该人群均进行胸部X线检查。随机选取443例患者采用低剂量螺旋CT检测;488例患者采用血清自身抗体进行检测;393例患者采用血清自身抗体联合低剂量螺旋CT检测。均随访一年,比较不同筛查方法对肺结节初筛阳性率及肺癌确诊率,早期肺癌筛查的敏感度及特异性。结果 血清自身抗体联合低剂量螺旋CT检测对于发现肺结节的初筛率、肺癌的确诊率及不同直径肺结节的检出率均明显高于低剂量螺旋CT组及血清自身抗体检测组（P<0.001）。血清自身抗体联合低剂量螺旋CT检测的特异性为89.1%,敏感度为88.4%,AUC为0.863。结论 血清自身抗体检测联合低剂量螺旋CT可明显提高高危人群早期肺癌筛查的确诊率,为寻找肺癌筛查路径提供理论依据。     

低剂量胸部CT筛查早期肺癌的临床应用研究

目的:探讨低剂量CT(low-dose chest CT,LDCT)胸部平扫在健康体检中筛查早期肺癌的应用效果及价值.方法:收集2018年1月至2018年12月在我院健康体检高危人群,采用低剂量胸部CT 1100例及胸部X线平片750例.结果:低剂量胸部CT与胸部X线片比较,发现肺结节病灶,阳性肺结节以及疑似肺癌的比例...     

Lung Cancer Screening Registry Reveals Low-dose CT Screening Remains Heavily Underutilized

BackgroundSince 2013, the United States Preventive Services Task Force has recommended annual screening for lung cancer in high-risk patients with low-dose computed tomography (LDCT). Current literature has provided estimates of the lung cancer screening rate and only prior to appropriate insurance coverage for LDCTs. The aim of this study was to use newly established registry data to assess the lung cancer screening rate across the United States.Materials and MethodsUsing data from the Lung Cancer Screening Registry provided by the American College of Radiology in 2016, we collected the total number of LDCT screens performed from all 1962 accredited radiographic screening sites. The 2015 National Health Interview Survey was used to estimate screening eligible smokers per United States Preventive Services Task Force criteria. These data were compared to calculate screening rate.ResultsIn 2016, 2.0% of 7.6 million eligible smokers were screened. Rates varied by region from 1.1% in the West to 3.9% in the Northeast. The South consisted of 40.4% of eligible smokers and the most accredited screening sites (37%); however, their screening rate was among the lowest (1.7%) in the nation. Smoking cessation counseling was offered to 84% of screened current smokers prior to receiving LDCTs.ConclusionsLung cancer screening remains heavily underutilized despite guideline recommendation since 2013, insurance coverage, and its potential to prevent thousands of lung cancer deaths annually.     

胸腔镜下肺段切除术治疗非小细胞肺癌的应用现状

早期非小细胞肺癌的治疗一直都以肺叶切除为主,近年来,随着腔镜技术的发展,胸腔镜下肺段切除术治疗早期肺癌成为另一个选择,为探讨该术式的安全可行性,本文就胸腔镜下肺段切除术的应用现状作一综述.     

Circulating microRNA signature as liquid-biopsy to monitor lung cancer in low-dose computed tomography screening

Liquid biopsies can detect biomarkers carrying information on the development and progression of cancer. We demonstrated that a 24 plasma-based microRNA signature classifier (MSC) was capable of increasing the specificity of low dose computed tomography (LDCT) in a lung cancer screening trial. In the present study, we tested the prognostic performance of MSC, and its ability to monitor disease status recurrence in LDCT screening-detected lung cancers.Between 2000 and 2010, 3411 heavy smokers enrolled in two screening programmes, underwent annual or biennial LDCT. During the first five years of screening, 84 lung cancer patients were classified according to one of the three MSC levels of risk: high, intermediate or low. Kaplan-Meier survival analysis was performed according to MSC and clinico-pathological information. Follow-up MSC analysis was performed on longitudinal plasma samples (n = 100) collected from 31 patients before and after surgical resection.Five-year survival was 88.9% for low risk, 79.5% for intermediate risk and 40.1% for high risk MSC (p = 0.001). The prognostic power of MSC persisted after adjusting for tumor stage (p = 0.02) and when the analysis was restricted to LDCT-detected cases after exclusion of interval cancers (p < 0.001). The MSC risk level decreased after surgery in 76% of the 25 high-intermediate subjects who remained disease free, whereas in relapsing patients an increase of the MSC risk level was observed at the time of detection of second primary tumor or metastatic progression.These results encourage exploiting the MSC test for lung cancer monitoring in LDCT screening for lung cancer.     

低剂量螺旋CT对肺内结节的诊断价值

目的 探讨低剂量螺旋CT(LDCT)扫描对肺内结节的诊断价值.方法 前瞻性随诊分析2002～2010年在我院行LDCT的302例患者的临床资料,胸部X线、常规剂量CT(SDCT)及LDCT的结果.结果 行LDCT检查者分两组:肺内结节待查组:共230例,男性120例(52.2%),女性110例(47.8%),中位年龄为...     

Scent test using Caenorhabditis elegans to screen for early-stage pancreatic cancer

Although early detection and diagnosis are indispensable for improving the prognosis of patients with pancreatic cancer, both have yet to be achieved. Except for pancreatic cancer, other cancers have already been screened through scent tests using animals or microorganisms, including Caenorhabditis elegans. While such a method may greatly improve the prognosis of pancreatic cancer, no studies have investigated the same, mainly given the difficulty of collecting suitable samples from patients with early-stage pancreatic cancer. In this study, we organized a nationwide study group comprising high-volume centers throughout Japan to collect patients with very-early-stage pancreatic cancer (stage 0 or IA). We initially performed an open-label study involving 83 cases (stage 0–IV), with subsequent results showing significant differences after surgical removal in stage 0–IA (×10 dilution: p < 0.001; ×100 dilution: p < 0.001). Thereafter, a blinded study on 28 cases (11 patients with stage 0 or IA disease and 17 healthy volunteers) was conducted by comparing very-early-stage pancreatic cancer patients with healthy volunteers to determine whether C. elegans could detect the scent of cancer for the diagnosis of early-stage pancreatic cancer. Preoperative urine samples had a significantly higher chemotaxis index compared to postoperative samples in patients with pancreatic cancer [×10 dilution: p < 0.001, area under the receiver operating characteristic curve (AUC) = 0.845; ×100 dilution: p < 0.001, AUC = 0.820] and healthy volunteers (×10 dilution: p = 0.034; ×100 dilution: p = 0.088). Moreover, using the changes in preoperative and postoperative chemotaxis index, this method had a higher sensitivity for detecting early pancreatic cancer compared to existing diagnostic markers. The clinical application C. elegans for the early diagnosis of cancer can certainly be expected in the near future.     

Role of chemotherapy and targeted therapy in early-stage non-small cell lung cancer

Introduction: Adjuvant platinum based chemotherapy is accepted as standard of care in stage II and III non-small cell lung cancer (NSCLC) patients and is often considered in patients with stage IB disease who have tumors ≥ 4 cm. The survival advantage is modest with approximately 5% at 5 years.

Areas covered: This review article presents relevant data regarding chemotherapy use in the perioperative setting for early stage NSCLC. A literature search was performed utilizing PubMed as well as clinical trial.gov. Randomized phase III studies in this setting including adjuvant and neoadjuvant use of chemotherapy as well as ongoing trials on targeted therapy and immunotherapy are also discussed.

Expert commentary: With increasing utilization of screening computed tomography scans, it is possible that the percentage of early stage NSCLC patients will increase in the coming years. Benefits of adjuvant chemotherapy in early stage NSCLC patients remain modest. There is a need to better define patients most likely to derive survival benefit from adjuvant therapy and spare patients who do not need adjuvant chemotherapy due to the toxicity of such therapy. Trials for adjuvant targeted therapy, including adjuvant EGFR-TKI trials and trials of immunotherapy drugs are ongoing and will define the role of these agents as adjuvant therapy.     

腹腔镜手术治疗早期子宫内膜癌的临床研究

目的：探讨腹腔镜手术治疗早期子宫内膜癌的临床疗效。方法选择98例接受治疗的子宫内膜癌患者,根据手术方式的不同分为腹腔镜组（n=49）和对照组（n=49）。腹腔镜组行腹腔镜手术,对照组行开腹手术,观察两组患者的术中出血量、淋巴结清扫个数、手术时间、留置导尿管时间、术后排气时间、术后住院时间等。测量手术开始时、手术1 h、手术结束时血液IL-1β水平,以及术前和术后7 d胰岛素样生长因子-1（IGF-1）、癌胚抗原（CEA）水平,统计术后并发症发生情况。结果腹腔镜组术中出血量、留置导尿管时间、术后排气时间、术后住院时间均少于对照组,手术时间长于对照组,差异均有统计学意义（P﹤0.05）。腹腔镜组手术1 h、手术结束时血液IL-1β水平均低于对照组,差异有统计学意义（P﹤0.05）。腹腔镜组术前及术后7 d的IGF-1、CEA水平均低于对照组,差异有统计学意义（P﹤0.05）。腹腔镜组术后并发症发病率（10.20%）低于对照组（26.53%）,差异有统计学意义（P﹤0.05）。结论腹腔镜手术治疗子宫内膜癌创伤小,对免疫系统影响小,术后并发症发生率低,值得应用于临床。