Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer
Autor: | Christine D. Berg, Denise R. Aberle, David S. Gierada, Sarah Baum, Fenghai Duan, Richard M. Fagerstrom, Pamela M. Marcus, Kathy L. Clingan, JoRean D. Sicks, Ilana F. Gareen, Amanda Jain, Irene Mahon, Timothy R. Church, William C. Black, Gordon C. Jones |
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Rok vydání: | 2013 |
Předmět: |
Male
medicine.medical_specialty Lung Neoplasms Radiography Radiation Dosage Sensitivity and Specificity Asymptomatic Article law.invention Randomized controlled trial law medicine Humans Stage (cooking) Lung cancer Early Detection of Cancer Aged business.industry Smoking Cancer General Medicine Middle Aged medicine.disease Annual Screening Female Radiography Thoracic National Lung Screening Trial Radiology medicine.symptom Tomography X-Ray Computed business |
Zdroj: | New England Journal of Medicine. 368:1980-1991 |
ISSN: | 1533-4406 0028-4793 |
Popis: | Background Lung cancer is the largest contributor to mortality from cancer. The National Lung Screening Trial (NLST) showed that screening with low-dose helical computed tomography (CT) rather than with chest radiography reduced mortality from lung cancer. We describe the screening, diagnosis, and limited treatment results from the initial round of screening in the NLST to inform and improve lung-cancer-screening programs. Methods At 33 U.S. centers, from August 2002 through April 2004, we enrolled asymptomatic participants, 55 to 74 years of age, with a history of at least 30 pack-years of smoking. The participants were randomly assigned to undergo annual screening, with the use of either low-dose CT or chest radiography, for 3 years. Nodules or other suspicious findings were classified as positive results. This article reports findings from the initial screening examination. Results A total of 53,439 eligible participants were randomly assigned to a study group (26,715 to low-dose CT and 26,724 to chest radiography); 26,309 participants (98.5%) and 26,035 (97.4%), respectively, underwent screening. A total of 7191 participants (27.3%) in the low-dose CT group and 2387 (9.2%) in the radiography group had a positive screening result; in the respective groups, 6369 participants (90.4%) and 2176 (92.7%) had at least one follow-up diagnostic procedure, including imaging in 5717 (81.1%) and 2010 (85.6%) and surgery in 297 (4.2%) and 121 (5.2%). Lung cancer was diagnosed in 292 participants (1.1%) in the low-dose CT group versus 190 (0.7%) in the radiography group (stage 1 in 158 vs. 70 participants and stage IIB to IV in 120 vs. 112). Sensitivity and specificity were 93.8% and 73.4% for low-dose CT and 73.5% and 91.3% for chest radiography, respectively. Conclusions The NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.). |
Databáze: | OpenAIRE |
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