% 0期刊文章%一个斯蒂芬·斯皮罗% Pallav l .沙%一个杰里米·乔治·罗伯特·c·Rintoul % %塞缪尔·琼斯%马修其%一个马可Novelli %一分钱肖% Gabrijela Kocjan %克里斯•格里菲思%玛丽Falzon %尼古拉斯·麦基理查德·Booton % %迈克尔·皮克%保罗Dhillon %一个基肖尔曾经%安德鲁·g·尼科尔森%西蒙Padley % Magali N亚洲艾哈迈德·泰勒% %一个杰克·艾伦% %严特耐Nyasha Chinyanganya %维多利亚Ashford-Turner %莎拉·刘易斯% Dahmane Oukrif %的帕梅拉·洛夫%一个艾伦Hackshaw尼古拉斯Counsell % % T连续筛查肺癌高危人群:随机对照试验% B LungSEARCH:随机对照试验的监测使用痰和成像的早期发现肺癌高危人群% D J 2019% R 10.1183/13993003.00581 -2019%欧洲呼吸杂志% P 1900581 % V 54% N 4% X背景低剂量计算机断层扫描(LDCT)筛查检测早期肺癌,降低死亡率。我们提出了一个连续的方法针对高危人群作为潜在的高效筛选策略。方法LungSEARCH全国多中心随机试验。当前/烟轻/中度慢性阻塞性肺疾病(COPD)被分配(1:1)5年的监测。筛选参与者提供年度痰标本细胞学和血细胞计数,如果异常提供年度LDCT和自发荧光支气管镜检查(空军基地)。那些正常的痰提供年度样本。主要终点是肺癌诊断的比例在阶段I / II (nonsmall细胞)或有限的疾病(小细胞)。结果2007 - 2011年期间1568名参与者被随机从10英国中心。85.2%的筛选提供了足够的基线痰液样本。有42个肺癌筛选785名个人和36肺癌783控制。42 54.8%(23)筛选个人和45.2%(31日)14日与已知的阶段被诊断出患有早期疾病的控制(单边p = 0.24)。相对危险度为1.21 (95% CI 0.75 - -1.95)或0.82 (95% CI 0.52 - -1.31)早期或晚期癌症,分别。 Overall sensitivity for sputum (in those randomised to surveillance) was low (40.5%) with a cumulative false-positive rate (FPR) of 32.8%. 55% of cancers had normal sputum results throughout. Among sputum-positive individuals who had AFB, sensitivity was 45.5% and cumulative FPR was 39.5%; the corresponding measures for those who had LDCT were 100% and 16.1%, respectively.Conclusions Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.While low-dose CT is now preferred for lung cancer screening, our randomised trial of smokers with COPD showed that a proposed sequential policy using sputum testing to select who receives low-dose CT and autofluorescence bronchoscopy was ineffective http://bit.ly/2JZujnx %U //www.qdcxjkg.com/content/erj/54/4/1900581.full.pdf