義大利S.Croce e Carle醫院胸腔外科Luca Bertolaccini博士在簡報中指出,去年發表的「國家肺臟篩檢試驗」(登載於N Engl J Med. 2011;365:395-409)顯示,使用低劑量CT肺癌篩檢可以降低肺癌特定死亡率達20%。
  DT的平均有效劑量為0.24 mSv;至於低劑量CT則為1.5 -3.8 mSv。DT的費用約為58美元,而低劑量CT的費用約為300美元。DT的執行也比CT快很多,Bertolaccini博士研究團隊進行中之觀察試驗的第一年結果顯示,DT偵測非鈣化結節的百分比和CT相當。
  ELCC共同主席、ESMO理事長候選人、簡報共同主持人Rolf A. Stahel博士指出, 胸部數位電腦斷層早期偵測肺癌的效率是值得多加關注的議題。
  共同主持人、IASLC執行長Paul Bunn醫師指出,「國家肺臟篩檢試驗」的病患選擇進行螺旋CT是因為他們是重度抽菸者(每年超過20包)且年紀大於55歲;該試驗中,陽性人數少且多數的陽性是偽陽性。

Chest DT Promising First-Line Tool for Lung Cancer Screening

By Megan Brooks
Medscape Medical News

April 19, 2012 (Geneva, Switzerland) — Chest digital tomosynthesis (DT) can help identify the best candidates for lung cancer screening with low-dose spiral computed tomography (CT), according to research presented here at the 3rd European Lung Cancer Conference (ELCC), which was coorganized by the European Society of Medical Oncology (ESMO) and the International Association for the Study of Lung Cancer (IASLC).

During a media briefing, Luca Bertolaccini, MD, PhD, from the thoracic surgery unit at S. Croce e Carle Hospital in Cuneo, Italy, noted that the landmark National Lung Cancer Screening Trial (N Engl J Med. 2011;365:395-409), published last year and reported at that time by Medscape Medical News, showed that lung cancer screening with low-dose CT can decrease lung-cancer-specific mortality by 20%.

Chest DT Before CT?

Low-dose CT is the only early-detection modality shown to improve survival rates; however, other methods of detecting lung cancer early that use less radiation and are less expensive than CT are needed, Dr. Bertolaccini explained. Chest DT might fit the bill "by helping to select people who are best suited for low-dose CT screening," he added.

The mean effective dose of DT is 0.24 mSv; for low-dose CT, it is 1.5 to 3.8 mSv. The cost of DT is around $58, whereas the cost of low-dose CT hovers around $300. DT is also much faster to do than CT, and first-year results from the ongoing observational trial by Dr. Bertolaccini's team show that it detects noncalcified nodules in a percentage comparable to CT.

"DT is limited-angle tomography that allows reconstruction of multiple image planes and provides high-resolution images in coronal planes at radiation doses and costs much lower than CT," he and his colleagues explain in their abstract.

Dr. Bertolaccini presented data on the first 1000 study patients (mean age, 61 years) who underwent chest DT, followed by a CT scan if a suspicious pulmonary lesion was found. All of them are heavy current or former smokers (at least 20 pack-years), with no malignancy in the 5 years before study entry.

In these first 1000 patients, the researchers report that chest DT detected at least 1 pulmonary abnormality in 154 subjects, extrapulmonary abnormalities in 7, effusions in 2, pleural lesions in 3, and mediastinal lymph node enlargement in 2.

Ninety-six patients (9.6%) underwent first-line CT for suspicious lesions. There were 32 false-positive DT nodules. DT detected 11 true lung cancers. The lung cancer detection rate was 1.1%.

"Great Interest" in Chest DT

"Our conclusion and our opinion is that digital chest tomosynthesis seems to be a promising first-line tool that helps to select persons best suited for low-dose CT," Dr. Bertolaccini said.

Rolf A. Stahel, MD, PhD, comoderator of the media briefing, ELCC cochair, and ESMO president-elect, noted that "the effectiveness of chest digital tomosynthesis for early detection of lung cancer is an issue that has...generated great interest."

Paul Bunn, MD, comoderator and IASLC executive director, noted that patients in the National Lung Cancer Screening Trial were selected for spiral CT because they were heavy smokers (more than 20 pack-years) and were older than 55 years; in that trial, "the number of positives was low and most of the positives were false positives."

"DT is not quite as sensitive as CT, but it's much cheaper.... Could this select people who would undergo a spiral CT scan rather than making the decision just on clinical features?" Dr. Bunn asked.

Additional data to come from Dr. Bertolaccini's study might provide more definitive answers.

The study was supported by a research grant from Fondazione Cassa di Risparmio di Cuneo. Dr. Bertolaccini, Dr. Stahel, and Dr. Bunn have disclosed no relevant financial relationships.

3rd European Lung Cancer Conference (ELCC): Abstract 63O. Presented April 18, 2012.

2015/4/15 上午 10:28:31
2012/6/20 下午 01:39:11
2012/6/18 下午 05:19:27

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