低剂量螺旋CT扫描对肺内结节的诊断价值
摘要
目的：
探讨低剂量螺旋CT扫描对肺内结节的诊断价值。
方法：
前瞻性随诊分析2002-2010年在我院行LDCT的302例病人的一般临床资料、X线胸片、常规剂量CT及低剂量螺旋CT的结果。
结果：
行LDCT检查者,男性156例(51.7%),女性146例(48.3%),上述病人分两组：一组因肺内结节待查行LDCT检查,共230例,男性120例(52.2%),女性110例(47.8%),中位年龄为65岁,>40岁216例(94.0%),吸烟史79例(34.3%),既往有肺部良性疾病史34例(14.8%),有毒及有害物质接触史30例(13.0%),有肿瘤家族史5例(2.2%),符合肺癌高危因素史人群112例(48.7%),95例(41.3%)无临床症状,60例病人行X线胸片及LDCT,LDCT检出的结节是X线胸片的2.4倍,164例病人行SDCT及LDCT,在结节检出及其影像学特征上无统计学差异,15例病人明确病理诊断,其中肺癌7例(3.0%),5例(71.4%)为Ⅰ期,另8例为肺内良性疾病；另一组为恶性肿瘤病人疗后随访行LDCT,共72例,男性36例(50%),女性36例(50%),68例发现肺内结节,其中26例诊断为原发肿瘤肺内转移。
结论：
LDCT检出肺内结节明显优于X线胸片；与SDCT比较,虽明显降低受检者辐射剂量,LDCT却不降低肺内结节的检出,且结节的影像学特征与SDCT无明显差异,LDCT对良恶性结节的检出有一定意义；LDCT将有利于提高肺癌的早期诊断,提高手术切除率,延长生存期,但LDCT能否作为肺癌筛查的方法尚需进一步探讨,如扫描的随访时间间隔、是否降低肺癌的死亡率、辐射风险、高假阳性率及效价比等问题。部分恶性肿瘤病人疗后定期行LDCT随访：可早期发现肺内转移及第二肺恶性肿瘤,安全性更好,有利于尽早制定治疗措施,改善病人的预后。
Objective:
To quantitate the effectiveness of low-dose spiral computed tomography (LDCT) in the identification of pulmonary nodules.
Materials and methods:
The prospective study included302patients who underwent LDCT scan of the chest in our hospital for the assenssment of pulmonanry nodules from2002to2010. Compare the numbers of nodules detected at chest X-ray, SDCT and LDCT.
Results:
302patients,156men and146women. Participants were divided into two groups:(a)230patients who took LDCT scan because of suspected pilmonanry nodules with chest X-ray or SDCT,120men,110women,94.0%age>40,79had a history of cigarette smoking,30had a history of occupational exposure (to asbestos or radon).95paetiets were asymptomatic,112were high-risk individuals,60patients underwent chest X-ray and LDCT scan, the LDCT-detected nodules were2.4times of that detected by chest X-ray.164patients underwent the CT examination at both standard and low dose, the LDCT-detected nodules were1.2times of that detected by SDCT. There were no statistically significant diffenrences in the imaging characters of the nodules detected at SDCT and LDCT. Biopsy of15lesions revealed lung cancer in7subjects,3.0%(7/230), with a high proportion of early tumor stages71.4%(5tumors, stage I),8lesions were benign.(b)In72patients who had a history of tumor, nodules were detected in68patients,26lesions were metastasis. Biopsy of1lesion revealed lung cancer, stage Ⅰ.
Conclusion:
The LDCT scan can be used more reliably in detection of pulmonary nodules than chest X-ray. Compared with SDCT, LDCT scan had not only reduced the radiation dose, but also had no statistically significant diffenrences in detecting of pulmonanry nodules and lung cancer. Cancer screening Of high-risk individuals will increase the numbers of lung cancer which were detected at early stage, prolong overall survival. Moreover, LDCT also increase the diagnosis of benign diseases of lung. A number of unresolved issues must be answered, such as wheather lung caner screening with LDCT will decrease in lung caner mortality, potential radiation risk, high false positive rate, the time of repeating screening and its cost-effectiveness. Tumor patients who were followed-up by LDCT, will find lung metastasis earlier than chest X-ray.Compared with SDCT,much safer.
探讨低剂量螺旋CT扫描对肺内结节的诊断价值。
方法：
前瞻性随诊分析2002-2010年在我院行LDCT的302例病人的一般临床资料、X线胸片、常规剂量CT及低剂量螺旋CT的结果。
结果：
行LDCT检查者,男性156例(51.7%),女性146例(48.3%),上述病人分两组：一组因肺内结节待查行LDCT检查,共230例,男性120例(52.2%),女性110例(47.8%),中位年龄为65岁,>40岁216例(94.0%),吸烟史79例(34.3%),既往有肺部良性疾病史34例(14.8%),有毒及有害物质接触史30例(13.0%),有肿瘤家族史5例(2.2%),符合肺癌高危因素史人群112例(48.7%),95例(41.3%)无临床症状,60例病人行X线胸片及LDCT,LDCT检出的结节是X线胸片的2.4倍,164例病人行SDCT及LDCT,在结节检出及其影像学特征上无统计学差异,15例病人明确病理诊断,其中肺癌7例(3.0%),5例(71.4%)为Ⅰ期,另8例为肺内良性疾病；另一组为恶性肿瘤病人疗后随访行LDCT,共72例,男性36例(50%),女性36例(50%),68例发现肺内结节,其中26例诊断为原发肿瘤肺内转移。
结论：
LDCT检出肺内结节明显优于X线胸片；与SDCT比较,虽明显降低受检者辐射剂量,LDCT却不降低肺内结节的检出,且结节的影像学特征与SDCT无明显差异,LDCT对良恶性结节的检出有一定意义；LDCT将有利于提高肺癌的早期诊断,提高手术切除率,延长生存期,但LDCT能否作为肺癌筛查的方法尚需进一步探讨,如扫描的随访时间间隔、是否降低肺癌的死亡率、辐射风险、高假阳性率及效价比等问题。部分恶性肿瘤病人疗后定期行LDCT随访：可早期发现肺内转移及第二肺恶性肿瘤,安全性更好,有利于尽早制定治疗措施,改善病人的预后。
Objective:
To quantitate the effectiveness of low-dose spiral computed tomography (LDCT) in the identification of pulmonary nodules.
Materials and methods:
The prospective study included302patients who underwent LDCT scan of the chest in our hospital for the assenssment of pulmonanry nodules from2002to2010. Compare the numbers of nodules detected at chest X-ray, SDCT and LDCT.
Results:
302patients,156men and146women. Participants were divided into two groups:(a)230patients who took LDCT scan because of suspected pilmonanry nodules with chest X-ray or SDCT,120men,110women,94.0%age>40,79had a history of cigarette smoking,30had a history of occupational exposure (to asbestos or radon).95paetiets were asymptomatic,112were high-risk individuals,60patients underwent chest X-ray and LDCT scan, the LDCT-detected nodules were2.4times of that detected by chest X-ray.164patients underwent the CT examination at both standard and low dose, the LDCT-detected nodules were1.2times of that detected by SDCT. There were no statistically significant diffenrences in the imaging characters of the nodules detected at SDCT and LDCT. Biopsy of15lesions revealed lung cancer in7subjects,3.0%(7/230), with a high proportion of early tumor stages71.4%(5tumors, stage I),8lesions were benign.(b)In72patients who had a history of tumor, nodules were detected in68patients,26lesions were metastasis. Biopsy of1lesion revealed lung cancer, stage Ⅰ.
Conclusion:
The LDCT scan can be used more reliably in detection of pulmonary nodules than chest X-ray. Compared with SDCT, LDCT scan had not only reduced the radiation dose, but also had no statistically significant diffenrences in detecting of pulmonanry nodules and lung cancer. Cancer screening Of high-risk individuals will increase the numbers of lung cancer which were detected at early stage, prolong overall survival. Moreover, LDCT also increase the diagnosis of benign diseases of lung. A number of unresolved issues must be answered, such as wheather lung caner screening with LDCT will decrease in lung caner mortality, potential radiation risk, high false positive rate, the time of repeating screening and its cost-effectiveness. Tumor patients who were followed-up by LDCT, will find lung metastasis earlier than chest X-ray.Compared with SDCT,much safer.
引文
1. American Cancer Society. Cancer facts and figures:1998. ACS, Atlanta,1-36
2. Juan P. Wisnivesky, Alvin I.Mushlin, Nachum Sicherman, et al.The cost-Effectiveness of Low-Dose CT screening for lung cancer Preliminary results of baseline screening. Chest,2003,124(2):614-621
3. Anderson RW. Carcinoma of the lung.Surg Clin North Am 1980,60 (4):793-814
4. Brett G. Z. Earlier diagnosis and survival in lung cancer. Br Med J,1969,4 (478):260-262
5. Rusinek H, Naidich DP, McGuinnesa G, Leitman BS, et al. Pulmonary nodule detection:low-dose versus conventional CT. Radiology,1998,209(1):243-249.
6. Parry RA,Glaze SA, Archer BR.Typical patient radiation doses in diagnostic radiology. Radiographics,1999,19 (5):1289-1302
7. N. Karabulut, M. Toru, V. Gelebe, et al. Comparison of low-dose and standard-dose helical CT in the evaluation of pulmonary. Eur Radiol,2002,12 (11):2764-2769
8. Naidich DP, Marshall CH, Gribbin C, Arams RS,Mccauley DI. Low-dose CT of the lungs:preliminary observations. Radiology,1990,175(3):729-731
9. Zwirewich CV, Mayo JR, Muller NL. Low-dose high-resolution CT of lung parenchyma.. Radiology,1991,180(2):413-417
10. Henschke Claudia I, Naidich DP, McGuinness G, et al. Early Lung Cancer Action Project:Initial Findings on Repeat Screening.Cancer,2001 92(1):153-159
11. Henschke Claudia I, David F, Daniel M. Libby, et al. Survival of patients with stage I Lung Cancer detected on CT Screening. The new England journal of medicine.2006,255(17):1763-1771
12. James G. R, Philip Costello, Gerard A. S. Screening for Lung Cancer. A JR,2008,190 (3):755-761
13. Sagawa M, Usuda k, Aikawa H, et al.Lung cancer screening and its efficacy. Gen Thorac Cardiovasc Surg,2009,57(10):519-527
14. Gohagan JK, Marcus PM, Fagerstrom RM, et al.Final results of the Lung Screening Study,a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer. Lung Cancer,2005,47 (1):9-15
15. David J. Brenner. Radiation risks potentially associated with Low-Dose CT screening of adult smokers for lung cancer. Radiology 2004,231 (2):440-445
16. Y Toyoda, T Nakayama, Y Kusunoki,H Iso, et al. Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography. British Journal of Cancer,2008,98(10):1602-1607
17. David SE, Wallace A, Gerold B, et al. National Comprehensive Cancer Network (NCCN) Practice Guidelines in Oncology-v.1.2010 for Non-Small Cell Lung Cancer
18. Naidich DP, Marshall CH, Gribbin C, Arams RS, Mccauley DI. Low-dose CT of the lungs:preliminary observations. Radiology,1990,175(3):729-731
19. Stefan Diederich, Priv Doz, Dr Med,et al. Screening for Early Lung Cancer with Low-Dose Spiral CT:Prevalence in 817 Asymptomatic Smokers. Radiology 2002,222 (3):773-781
20. Henschke CI, Naidich DP, McGuinness G, et al. Early Lung Cancer Action Project:Initial Findings on Repeat Screening. Cancer,2001 92(1):153-159
21.Gianpiero Fasola, Ornella Belvedere,Marianna Aita, et al. Low-Dose Computed Tomography Screening for Lung Cancer and Pleural Mesothelioma in an Asbestos-Exposed Population:Baseline Results of a Prospective, Nonrandomized Feasibility Trial—An Alpe-Adria Thoracic Oncology Multidisciplinary group Study (ATOM 002). The Oncologist,2007,12(10):1215-1224
22. Takeshi Nawa MD, Tohru Nakagawa MD, Suzushikusano MD, et al. Lung cancer screening using low-dose spiral CT:results of baseline an 1-year follow-up studies. Chest,2002,122 (1):15-20
23. Kubik AK, Parkin DM, Zatloukal P. Czech study on lung cancer screening: post-trial follow-up of lung cancer deaths up to year 15 since enrollment. Cancer 2000,89 (11 Suppl):2363-2368
24. Marcus P, Bergstralh E, Fagerstrom R, et al. Lung cancer mortality in Mayo Lung Project:impact of extended follow up. J Natl Cancer Inst 2000,92 (16):1308-1316
25. Sone S, Nakayama T,Honda T, et al. Long-term follow-up study of a population-based 1996-1998 mass screening program for lung cancer using mobile low-dose spiral computed tomography. Lung Cancer,2007,58 (3):329-41
26. Swensen SJ, Jett JR,Hartman TE, et al.CT screening for lung cancer: five-year prospective experience. Radiology 2005,235 (1):259-265
27. Sagawa M, Usuda k,Aikawa H, et al.Lung cancer screening and its efficacy. Gen Thorac Cardiovasc Surg,2009,57(10):519-527
28. Jennings SG, Winer-Muram HT, Tann M, et al. Distribution of stage I lung cancer growth rates determined with serial volumetric CT measurements. Radiology 2006,241 (2):554-563
29. James G. R, Philip Costello, Gerard A. S. Screening for Lung Cancer. AJR,2008,190 (3):755-761
30. Clark KW, Gierada DS, Marquez G, et al. Collecting 48000 CT exams for the Lung Screening study of the National Lung Screening trial.J Diagit Imaging,2009,22(6):667-680
31. Van Iersel CA, De Koning HJ, Draisma G, et al. Risk-based selection from the general population in a screening trial:selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer Multi-slice CT screening trial (NELSON). Int J Cancer,2007,120 (4):868-874
32. Marshall E. A bruishing battle over lung scans. Science,2008,320 (5889):600-603
33. Twombly R. Lung cancer screening debate continues despite international CT study results. J Natl Cancer Inst,2007,99 (3):190-195
34. David J. Brenner. Radiation risks potentially associated with Low-Dose CT screening of adult smokers for lung cancer. Radiology 2004,231 (2):440-445
1. American Cancer Society. Cancer facts and figures:1998. ACS, Atlanta,1-36
2. Juan P. Wisnivesky, Alvin I.Mushlin, Nachum Sicherman, et al.The cost-Effectiveness of Low-Dose CT screening for lung cancer Preliminary results of baseline screening. Chest,2003,124(2):614-621
3. Anderson RW. Carcinoma of the lung. Surg Clin North Am 1980, 60(4):793-814
4. Brett G. Z. Earlier diagnosis and survival in lung cancer. Br Med J,1969,4 (478):260-262
5. Rusinek H, Naidich DP, McGuinnesa G, Leitman BS, et al. Pulmonary nodule detection:low-dose versus conventional CT. Radiology,1998,209(1):243-249.
6. Parry RA, Glaze SA, Archer BR.Typical patient radiation doses in diagnostic radiology. Radiographics,1999,19(5):1289-1302
7. N. Karabulut, M. Toru, V. Gelebe, et al. Comparison of low-dose and standard-dose helical CT in the evaluation of pulmonary. Eur Radiol.2002,12 (11):2764-2769
8. Naidich DP, Marshall CH, Gribbin C, Arams RS,Mccauley DI. Low-dose CT of the lungs:preliminary observations. Radiology,1990,175(3):729-731
9. Zwirewich CV, Mayo JR, Muller NL. Low-dose high-resolution CT of lung parenchyma.. Radiology,1991,180(2):413-417
10. Diederich S, Lenzen H, Windmann R, Puskas Z, et al.Pulmonary nodules: experimental and clinical studies at low-dose CT. Radiology,1999,213 (1):289-298
11. Joseph K. L, Thomas E. W, Carl R. F, et al. Pulmonary Nodule Detection with Low-Dose CT of the Lung:Agreement Among Radiologists. Chest Imaging Original Research, AJR 2005,185 (4):973-978
12. Henschke CI, Naidich DP, McGuinness G, et al. Early Lung Cancer Action Project:Initial Findings on Repeat Screening. Cancer,2001 92(1):153-159
13. Gianpiero Fasola, Ornella Belvedere, Marianna Aita, et al.Low-Dose Computed Tomography Screening for Lung Cancer and Pleural Mesothelioma in an Asbestos-Exposed Population:Baseline Results of a Prospective, Nonrandomized Feasibility Trial—An Alpe-Adria Thoracic Oncology Multidisciplinary group Study (ATOM 002). The Oncologist,2007,12(10):1215-1224
14. Henschke CI, Yankelevitz DF, Libby DM, et al. Survival of Patients with Stage I Lung Cancer Detected on CT Screening. The New England Journal of Medicine,2006,355(17):1763-1771
15. Sone S, Nakayama T, Honda T, et al. Long-term follow-up study of a population-based 1996-1998 mass screening program for lung cancer using mobile low-dose spiral computed tomography. Lung Cancer,2007,58 (3):329-41
16.Stefan Diederich, Priv Doz, Dr Med, et al.Screening for Early Lung Cancer with Low-Dose Spiral CT:Prevalence in 817 Asymptomatic Smokers.Radiology 2002,222 (3):773-781
17. Winer Muram HT, Jennings SG, Tarver RD, et al. Volumetric growth rate of stage I lung cancer prior to treatment:serial CT scanning. Radiology,2002,223 (3):798-805
18. MacRedmond R, McVey G, Lee M, et al. Screening for lung cancer using low dose CT scanning:results of 2 year follow up. Thorax,2006,61 (1):54-56
19.Henschke CI,McCaule DI,Yankelevitiz DF, et al. Early Lung Cancer Action Project:overall design and findings from baseline screening. THE LANCET,1999,354(9173):99-105
20. Dieherich S, Wormanns D, Heindel W. Low-dose CT new tool for screening lung cancer. European Radiology,2001,11(10):1916-1924
21. James G. R, Philip Costello, Gerard A. S. Screening for Lung Cancer. AJR,2008,190 (3):755-761
22. Sagawa M, Usuda k,Aikawa H, et al.Lung cancer screening and its efficacy.Gen Thorac Cardiovasc Surg,2009,57(10):519-527
23. Patz EF Jr, Rossi S, Harpolo DH Jr, et al. Correlation of tumor size and survival in patients with stage I A non-small cell lung cancer. Chest,2000,117(6):1568-1571
24.Gohagan JK, Marcus PM, Fagerstrom RM, et al. Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer. Lung Cancer,2005,47 (1):9-15
25. Nackaerts K, Vansteenkiste J. Low-Dose CT Screening for Lung Cancer: Trial and Error? Journal of Thoracic Oncology,2009,4(5):608-614
26. Clark KW, Gierada DS, Marquez G, et al. Collecting 48000 CT exams for the Lung Screening study of the National Lung Screening trial. J Diagit Imaging,2009,22(6):667-680
27. Van Iersel CA, De Koning HJ, Draisma G, et al. Risk-based selection from the general population in a screening trial:selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer Multi-slice CT screening trial (NELSON). Int J Cancer,2007,120 (4):868-874
28.Marshall E. A bruishing battle over lung scans. Science,2008,320 (5889):600-603
29. Twombly R. Lung cancer screening debate continues despite international CT study results. J Natl Cancer Inst,2007,99 (3):190-195
30. David J. Brenner. Radiation risks potentially associated with Low-Dose CT screening of adult smokers for lung cancer. Radiology 2004,231 (2):440-445
31. Y Toyoda, T Nakayama, Y Kusunoki,H Iso, et al. Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography. British Journal of Cancer,2008,98(10):1602-1607
32.David SE, Wallace A, Gerold B, et al. National Comprehensive Cancer Network (NCCN) Practice Guidelines in Oncology-v.1.2010 for Non-Small Cell Lung Cancer
2. Juan P. Wisnivesky, Alvin I.Mushlin, Nachum Sicherman, et al.The cost-Effectiveness of Low-Dose CT screening for lung cancer Preliminary results of baseline screening. Chest,2003,124(2):614-621
3. Anderson RW. Carcinoma of the lung.Surg Clin North Am 1980,60 (4):793-814
4. Brett G. Z. Earlier diagnosis and survival in lung cancer. Br Med J,1969,4 (478):260-262
5. Rusinek H, Naidich DP, McGuinnesa G, Leitman BS, et al. Pulmonary nodule detection:low-dose versus conventional CT. Radiology,1998,209(1):243-249.
6. Parry RA,Glaze SA, Archer BR.Typical patient radiation doses in diagnostic radiology. Radiographics,1999,19 (5):1289-1302
7. N. Karabulut, M. Toru, V. Gelebe, et al. Comparison of low-dose and standard-dose helical CT in the evaluation of pulmonary. Eur Radiol,2002,12 (11):2764-2769
8. Naidich DP, Marshall CH, Gribbin C, Arams RS,Mccauley DI. Low-dose CT of the lungs:preliminary observations. Radiology,1990,175(3):729-731
9. Zwirewich CV, Mayo JR, Muller NL. Low-dose high-resolution CT of lung parenchyma.. Radiology,1991,180(2):413-417
10. Henschke Claudia I, Naidich DP, McGuinness G, et al. Early Lung Cancer Action Project:Initial Findings on Repeat Screening.Cancer,2001 92(1):153-159
11. Henschke Claudia I, David F, Daniel M. Libby, et al. Survival of patients with stage I Lung Cancer detected on CT Screening. The new England journal of medicine.2006,255(17):1763-1771
12. James G. R, Philip Costello, Gerard A. S. Screening for Lung Cancer. A JR,2008,190 (3):755-761
13. Sagawa M, Usuda k, Aikawa H, et al.Lung cancer screening and its efficacy. Gen Thorac Cardiovasc Surg,2009,57(10):519-527
14. Gohagan JK, Marcus PM, Fagerstrom RM, et al.Final results of the Lung Screening Study,a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer. Lung Cancer,2005,47 (1):9-15
15. David J. Brenner. Radiation risks potentially associated with Low-Dose CT screening of adult smokers for lung cancer. Radiology 2004,231 (2):440-445
16. Y Toyoda, T Nakayama, Y Kusunoki,H Iso, et al. Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography. British Journal of Cancer,2008,98(10):1602-1607
17. David SE, Wallace A, Gerold B, et al. National Comprehensive Cancer Network (NCCN) Practice Guidelines in Oncology-v.1.2010 for Non-Small Cell Lung Cancer
18. Naidich DP, Marshall CH, Gribbin C, Arams RS, Mccauley DI. Low-dose CT of the lungs:preliminary observations. Radiology,1990,175(3):729-731
19. Stefan Diederich, Priv Doz, Dr Med,et al. Screening for Early Lung Cancer with Low-Dose Spiral CT:Prevalence in 817 Asymptomatic Smokers. Radiology 2002,222 (3):773-781
20. Henschke CI, Naidich DP, McGuinness G, et al. Early Lung Cancer Action Project:Initial Findings on Repeat Screening. Cancer,2001 92(1):153-159
21.Gianpiero Fasola, Ornella Belvedere,Marianna Aita, et al. Low-Dose Computed Tomography Screening for Lung Cancer and Pleural Mesothelioma in an Asbestos-Exposed Population:Baseline Results of a Prospective, Nonrandomized Feasibility Trial—An Alpe-Adria Thoracic Oncology Multidisciplinary group Study (ATOM 002). The Oncologist,2007,12(10):1215-1224
22. Takeshi Nawa MD, Tohru Nakagawa MD, Suzushikusano MD, et al. Lung cancer screening using low-dose spiral CT:results of baseline an 1-year follow-up studies. Chest,2002,122 (1):15-20
23. Kubik AK, Parkin DM, Zatloukal P. Czech study on lung cancer screening: post-trial follow-up of lung cancer deaths up to year 15 since enrollment. Cancer 2000,89 (11 Suppl):2363-2368
24. Marcus P, Bergstralh E, Fagerstrom R, et al. Lung cancer mortality in Mayo Lung Project:impact of extended follow up. J Natl Cancer Inst 2000,92 (16):1308-1316
25. Sone S, Nakayama T,Honda T, et al. Long-term follow-up study of a population-based 1996-1998 mass screening program for lung cancer using mobile low-dose spiral computed tomography. Lung Cancer,2007,58 (3):329-41
26. Swensen SJ, Jett JR,Hartman TE, et al.CT screening for lung cancer: five-year prospective experience. Radiology 2005,235 (1):259-265
27. Sagawa M, Usuda k,Aikawa H, et al.Lung cancer screening and its efficacy. Gen Thorac Cardiovasc Surg,2009,57(10):519-527
28. Jennings SG, Winer-Muram HT, Tann M, et al. Distribution of stage I lung cancer growth rates determined with serial volumetric CT measurements. Radiology 2006,241 (2):554-563
29. James G. R, Philip Costello, Gerard A. S. Screening for Lung Cancer. AJR,2008,190 (3):755-761
30. Clark KW, Gierada DS, Marquez G, et al. Collecting 48000 CT exams for the Lung Screening study of the National Lung Screening trial.J Diagit Imaging,2009,22(6):667-680
31. Van Iersel CA, De Koning HJ, Draisma G, et al. Risk-based selection from the general population in a screening trial:selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer Multi-slice CT screening trial (NELSON). Int J Cancer,2007,120 (4):868-874
32. Marshall E. A bruishing battle over lung scans. Science,2008,320 (5889):600-603
33. Twombly R. Lung cancer screening debate continues despite international CT study results. J Natl Cancer Inst,2007,99 (3):190-195
34. David J. Brenner. Radiation risks potentially associated with Low-Dose CT screening of adult smokers for lung cancer. Radiology 2004,231 (2):440-445
1. American Cancer Society. Cancer facts and figures:1998. ACS, Atlanta,1-36
2. Juan P. Wisnivesky, Alvin I.Mushlin, Nachum Sicherman, et al.The cost-Effectiveness of Low-Dose CT screening for lung cancer Preliminary results of baseline screening. Chest,2003,124(2):614-621
3. Anderson RW. Carcinoma of the lung. Surg Clin North Am 1980, 60(4):793-814
4. Brett G. Z. Earlier diagnosis and survival in lung cancer. Br Med J,1969,4 (478):260-262
5. Rusinek H, Naidich DP, McGuinnesa G, Leitman BS, et al. Pulmonary nodule detection:low-dose versus conventional CT. Radiology,1998,209(1):243-249.
6. Parry RA, Glaze SA, Archer BR.Typical patient radiation doses in diagnostic radiology. Radiographics,1999,19(5):1289-1302
7. N. Karabulut, M. Toru, V. Gelebe, et al. Comparison of low-dose and standard-dose helical CT in the evaluation of pulmonary. Eur Radiol.2002,12 (11):2764-2769
8. Naidich DP, Marshall CH, Gribbin C, Arams RS,Mccauley DI. Low-dose CT of the lungs:preliminary observations. Radiology,1990,175(3):729-731
9. Zwirewich CV, Mayo JR, Muller NL. Low-dose high-resolution CT of lung parenchyma.. Radiology,1991,180(2):413-417
10. Diederich S, Lenzen H, Windmann R, Puskas Z, et al.Pulmonary nodules: experimental and clinical studies at low-dose CT. Radiology,1999,213 (1):289-298
11. Joseph K. L, Thomas E. W, Carl R. F, et al. Pulmonary Nodule Detection with Low-Dose CT of the Lung:Agreement Among Radiologists. Chest Imaging Original Research, AJR 2005,185 (4):973-978
12. Henschke CI, Naidich DP, McGuinness G, et al. Early Lung Cancer Action Project:Initial Findings on Repeat Screening. Cancer,2001 92(1):153-159
13. Gianpiero Fasola, Ornella Belvedere, Marianna Aita, et al.Low-Dose Computed Tomography Screening for Lung Cancer and Pleural Mesothelioma in an Asbestos-Exposed Population:Baseline Results of a Prospective, Nonrandomized Feasibility Trial—An Alpe-Adria Thoracic Oncology Multidisciplinary group Study (ATOM 002). The Oncologist,2007,12(10):1215-1224
14. Henschke CI, Yankelevitz DF, Libby DM, et al. Survival of Patients with Stage I Lung Cancer Detected on CT Screening. The New England Journal of Medicine,2006,355(17):1763-1771
15. Sone S, Nakayama T, Honda T, et al. Long-term follow-up study of a population-based 1996-1998 mass screening program for lung cancer using mobile low-dose spiral computed tomography. Lung Cancer,2007,58 (3):329-41
16.Stefan Diederich, Priv Doz, Dr Med, et al.Screening for Early Lung Cancer with Low-Dose Spiral CT:Prevalence in 817 Asymptomatic Smokers.Radiology 2002,222 (3):773-781
17. Winer Muram HT, Jennings SG, Tarver RD, et al. Volumetric growth rate of stage I lung cancer prior to treatment:serial CT scanning. Radiology,2002,223 (3):798-805
18. MacRedmond R, McVey G, Lee M, et al. Screening for lung cancer using low dose CT scanning:results of 2 year follow up. Thorax,2006,61 (1):54-56
19.Henschke CI,McCaule DI,Yankelevitiz DF, et al. Early Lung Cancer Action Project:overall design and findings from baseline screening. THE LANCET,1999,354(9173):99-105
20. Dieherich S, Wormanns D, Heindel W. Low-dose CT new tool for screening lung cancer. European Radiology,2001,11(10):1916-1924
21. James G. R, Philip Costello, Gerard A. S. Screening for Lung Cancer. AJR,2008,190 (3):755-761
22. Sagawa M, Usuda k,Aikawa H, et al.Lung cancer screening and its efficacy.Gen Thorac Cardiovasc Surg,2009,57(10):519-527
23. Patz EF Jr, Rossi S, Harpolo DH Jr, et al. Correlation of tumor size and survival in patients with stage I A non-small cell lung cancer. Chest,2000,117(6):1568-1571
24.Gohagan JK, Marcus PM, Fagerstrom RM, et al. Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer. Lung Cancer,2005,47 (1):9-15
25. Nackaerts K, Vansteenkiste J. Low-Dose CT Screening for Lung Cancer: Trial and Error? Journal of Thoracic Oncology,2009,4(5):608-614
26. Clark KW, Gierada DS, Marquez G, et al. Collecting 48000 CT exams for the Lung Screening study of the National Lung Screening trial. J Diagit Imaging,2009,22(6):667-680
27. Van Iersel CA, De Koning HJ, Draisma G, et al. Risk-based selection from the general population in a screening trial:selection criteria, recruitment and power for the Dutch-Belgian randomised lung cancer Multi-slice CT screening trial (NELSON). Int J Cancer,2007,120 (4):868-874
28.Marshall E. A bruishing battle over lung scans. Science,2008,320 (5889):600-603
29. Twombly R. Lung cancer screening debate continues despite international CT study results. J Natl Cancer Inst,2007,99 (3):190-195
30. David J. Brenner. Radiation risks potentially associated with Low-Dose CT screening of adult smokers for lung cancer. Radiology 2004,231 (2):440-445
31. Y Toyoda, T Nakayama, Y Kusunoki,H Iso, et al. Sensitivity and specificity of lung cancer screening using chest low-dose computed tomography. British Journal of Cancer,2008,98(10):1602-1607
32.David SE, Wallace A, Gerold B, et al. National Comprehensive Cancer Network (NCCN) Practice Guidelines in Oncology-v.1.2010 for Non-Small Cell Lung Cancer