低剂量螺旋CT和痰液基薄层细胞学联合筛查社区肺癌高危人群的研究

目的 评价低剂量螺旋CT（low-dose computed tomography, LDCT）和痰液基薄层细胞学检测（thinprep cytologic test, TCT）对社区肺癌高危人群的联合筛查效果。方法 对2013年8月~2014年9月在社区招募符合本研究高危人群定义的3 708名东莞本地居民进行肺癌筛查。肺癌高危人群定义为符合下列任何一项的40岁以上者：20包年以上的吸烟史，肺癌家族史，肺部既往病史，职业接触史或被动吸烟史。发现至少一个直径≥4 mm 非钙化结节为LDCT筛查的阳性结果；细胞学重度不典型增生或镜检可见癌细胞为TCT检查的阳性结果。结果 LDCT肺部结节的检出率为12.59%（467/3 708）。经病理证实，LDCT筛查阳性人群中共确诊肺癌56例，检出率为1.51%（56/3 708）。TCT的阳性检出率为1.91%（71/3 708）。TCT阳性人群中共确诊肺癌36例，肺癌检出率为0.97%（36/3 708）。本次联合筛查共确诊肺癌58例，非小细胞肺癌41例，其中0～Ⅰ 期22例，早期诊断率为53.66%（22/41）。结论 LDCT和TCT联合筛查肺癌高危人群有助于提高肺癌的早期诊断率和检出率，降低筛查的假阳性比例。

Study on united screening of low-dose computed tomography combined with thinprep cytologic test of lung cancer among high risk groups in community

Objective To evaluate the screening effectiveness of low-dose computed tomography (LDCT) combined with thinprep cytologic test (TCT) of lung cancer in high risk groups from local community. Methods 3 708 community residents with high risk for lung cancer were enrolled in this research. People who defined as high risk groups of lung cancer must be above 40 years old and at least fit for one of the following four factors: smoking history above 20 pack years, family history of lung cancer, history of lung disease, history of occupational hazardous exposure and second-hand cigarette history. LDCT scans revealed any non-calcified nodule diameter measuring at least 4 mm was classified as positive outcome. Cytological dysplasia or cancer cells for microscopic examination suggested positive results of TCT. Results A total of 3 708 people at high risk for lung cancer underwent screening test,12.59% (467/3 708)participants' LDCT examination showed at least one non-calcified nodule with diameter≥4 mm. The pathological biopsy confirmed that 56 cases of lung cancer were diagnosis correctly among LDCT positive subjects, the detection rate of lung cancer was 1.51% (56/3 708). TCT positive rate was 1.91% (71/3 708). Also 0.97% (36/3 708) cases were diagnosed correctly after pathological biopsy. 58 cases of lung cancer were screened out by united screening of LDCT and TCT. 41 patients with non small cell lung cancer and 22 patients were classified as 0~Ⅰ phase, the early diagnosis rate was 53.66% (22/41). Conclusions The LDCT combined with TCT screening is helpful to improve the early diagnosis rate and detection rate of lung cancer. Also be good for decreasing the false positive rate.