抽象
背景虽然低剂量计算机断层扫描(LDCT)在肺癌筛查中已广泛应用于临床,但与从不吸烟者中筛查出的结节相关的诊断程序的特点和结果仍不清楚。我们的目的是确定浸润性活检的结节发生率,并与接受过LDCT筛查的吸烟者相比,评估从不吸烟者的最终诊断和手术相关并发症。
方法We evaluated 37 436 asymptomatic adults (17 968 never-smokers and 19 468 ever-smokers) who underwent LDCT screening for lung cancer between January 2009 and December 2018 at a tertiary centre in South Korea. The rates of invasive diagnostic procedures for detected nodules and related complications, and the diagnostic outcomes were determined in the never-smoker and ever-smoker groups.
结果Among the never-smokers, 2908/17 968 (16.2%) had positive nodules. Overall, 139/17 968 (0.77%) never-smokers and 194/19 468 (1.00%) ever-smokers underwent invasive biopsy (p=0.022). Lung cancer was diagnosed in 84/17 968 (0.47%) of never-smokers and 123/19 468 (0.63%) of ever-smokers (p=0.032). The proportions of participants diagnosed with benign disease after invasive biopsy (false-positive) were 50/17 968 (0.28%) and 69/19 468 (0.35%) in the never-smoker and ever-smoker groups (p=0.191). Multivariate analyses revealed no significant associations of smoking with the risk of a false-positive diagnosis (OR=0.98, 95% CI=0.62–1.57) and complications (OR=1.33, 95% CI=0.65–3.73) after biopsy. Of the 84 never-smokers with lung cancer, 82/84 (97.6%) had adenocarcinoma, and 75/84 (89.3%) were in stage I with a favourable prognosis.
结论对从不吸烟者进行LDCT筛查,可显著提高肺结节的检出率,值得进行有创活检。从未吸烟者的肺癌检出率低于曾经吸烟者。但两组假阳性率及并发症发生率无显著性差异。因此,需要一种更为具体的管理策略来筛选亚洲从不吸烟者中检测到的结节。
脚注
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- 收到2020年1月28日。
- 认可的2020年5月22日。
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