低剂量CT和胸片在社区高危人群肺癌筛查中的价值
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摘要
目的分析低剂量CT(LDCT)和直接数字化X射线摄影系统(DR)胸片在社区高危人群肺癌筛查中的价值。方法选取363例社区肺癌高危人群作为研究对象,均行LDCT检查和DR胸片检查,对筛查阳性者给予转诊并最终确诊是否为肺癌,对比分析2种筛查方法的诊断有效率。结果影像学筛查阳性者为104例,阳性率为28.65%,其中,LDCT筛查阳性者为85例,DR胸片筛查阳性者为61例,阳性率分别为23.42%、16.8%,差异有统计学意义(P<0.05);104例筛查阳性者全部转诊综合性医院进行检查,最终62例确诊为肺癌,患病率为17.08%。在LDCT筛查阳性者中,有61例确诊为肺癌,在DR胸片筛查阳性者中,有45例确诊为肺癌,检出率分别为98.39%、72.58%,差异有统计学意义(P<0.05)。LDCT、DR胸片在肺癌筛查中的受试者工作特征曲线下面积(AUC)分别为0.706和0.672(P<0.05),灵敏度和特异度分别为0.984和0.429、0.726和0.619。当将二者联合检测时,AUC提高到了0.784(P<0.05),灵敏度和特异度分别为0.726和0.738。结论 LDCT和DR胸片在社区高危人群肺癌筛查中均具有一定的价值,其中,LDCT的灵敏度较高,筛查效果好于DR胸片,将2种影像学筛查方法联合应用时,可在一定程度上提高筛查效率和特异度。
Objective To analyze the values of low-dose CT(LDCT) and direct digital Xray radiography(DR) chest film in screening lung cancer among high-risk population in community.Methods A total of 363 high-risk population for lung cancer in community were selected as the research subjects.LDCT and DR chest film were performed simultaneously for all the subjects.The positive screened people were transferred to other hospitals and to confirm whether they were finally diagnosed as lung cancer.The diagnostic efficacy of the two screening methods was compared and analyzed.Results There were 104 cases were positive in imaging screening,the positive rate was28.65%,among whom 85 cases were LDCT positive,61 cases were DR positive,with the positive rate of 23.42% and 16.8%,respectively(P<0.05).All the 104 cases with positive screening results were transferred to the general hospital for further confirmation.Finally,62 cases were diagnosed as lung cancer,the prevalence rate was 17.08%.Among the LDCT positive cases,61 cases were diagnosed as lung cancer,and 45 cases were diagnosed as lung cancer in DR positive cases.The detection rates were 98.39% and 72.58%,respectively.The difference was statistically significant(P<0.05).The Area under receiver operating characteristic curve(AUC) of LDCT and DR chest film in screening lung cancer were 0.706 and 0.672,respectively(P<0.05).The sensitivity and specificity were 0.984 and 0.429,0.726 and 0.619,respectively.When combined detection of LDCT andDR chest films applied,AUC was increased to 0.784(P<0.05),and the sensitivity and specificity were 0.7 2 6 and 0.7 3 8,respectively.Conclusion LDCT and DR chest X-ray film is of great value in screening lung cancer in the high-risk population in the community.LDCT has higher sensitivity and better screening effects than DR chest X-ray film.The combined screening methods can improve the screening efficiency and specificity to a certain extent.
Objective To analyze the values of low-dose CT(LDCT) and direct digital Xray radiography(DR) chest film in screening lung cancer among high-risk population in community.Methods A total of 363 high-risk population for lung cancer in community were selected as the research subjects.LDCT and DR chest film were performed simultaneously for all the subjects.The positive screened people were transferred to other hospitals and to confirm whether they were finally diagnosed as lung cancer.The diagnostic efficacy of the two screening methods was compared and analyzed.Results There were 104 cases were positive in imaging screening,the positive rate was28.65%,among whom 85 cases were LDCT positive,61 cases were DR positive,with the positive rate of 23.42% and 16.8%,respectively(P<0.05).All the 104 cases with positive screening results were transferred to the general hospital for further confirmation.Finally,62 cases were diagnosed as lung cancer,the prevalence rate was 17.08%.Among the LDCT positive cases,61 cases were diagnosed as lung cancer,and 45 cases were diagnosed as lung cancer in DR positive cases.The detection rates were 98.39% and 72.58%,respectively.The difference was statistically significant(P<0.05).The Area under receiver operating characteristic curve(AUC) of LDCT and DR chest film in screening lung cancer were 0.706 and 0.672,respectively(P<0.05).The sensitivity and specificity were 0.984 and 0.429,0.726 and 0.619,respectively.When combined detection of LDCT andDR chest films applied,AUC was increased to 0.784(P<0.05),and the sensitivity and specificity were 0.7 2 6 and 0.7 3 8,respectively.Conclusion LDCT and DR chest X-ray film is of great value in screening lung cancer in the high-risk population in the community.LDCT has higher sensitivity and better screening effects than DR chest X-ray film.The combined screening methods can improve the screening efficiency and specificity to a certain extent.
引文
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[12]刘玉萍,冯刚.体检人群低剂量CT早期肺癌筛查结果及危险因素分析[J].中华老年医学杂志,2017,24(11):1242-1246.
[13]高忠嵩,叶兆祥,张鹏,等.天津地区低剂量CT肺癌基线筛查与随访的初步临床分析[J].中国肿瘤临床,2017,44(20):1034-1039.
[14]马艳.低剂量CT扫描对肺部小结节的诊断价值[J].中国民康医学,2018,30(1):100-101.
[15]李捷.常规剂量和低剂量CT扫描诊断肺结节的意义探析[J].中国继续医学教育,2018,10(7):49-51.
[16]孙琦,黄遥,赵世俊,等.低剂量CT肺癌筛查中持续存在肺结节的CT体积和质量增长及其影响因素[J].中华肿瘤杂志,2018,25(4):274-279.
[17]徐红卫.低剂量CT在肺癌术后短期复查中的应用价值[J].现代诊断与治疗,2017,28(13):2502-2503.
[18]纪颖,薛迪.低剂量CT用于肺癌筛查的Meta分析[J].实用癌症杂志,2017,33(8):1283-1287.
[19]孟善进.低剂量CT在筛查及鉴别疑似肺癌患者中的应用[J].湖南师范大学学报:医学版,2017,19(6):181-185.
[2]杨启顺.肺癌早期诊断的影像技术研究进展[J].影像研究与医学应用,2018,2(10):5-6.
[3]张娜,武志峰.CT纹理分析在肺癌诊断中的应用研究进展[J].中国现代医药杂志,2018,20(2):95-98.
[4]叶凯,袁慧书.超低剂量CT在胸部疾病诊断的研究进展[J].实用放射学杂志,2018,34(4):621-623,644.
[5]Xin X,Shen J,Yang S,et al.Improved image quality of lowdose CT combining with iterative model reconstruction algorithm for response assessment in patients after treatment of malignant tumor[J].Quant Imaging Med Surg,2018,8(7):648-657.
[6]Jin S,Zhang B,Zhang L,et al.Lung nodules assessment in ultra-low-dose CT with iterative reconstruction compared to conventional dose CT[J].Quant Imaging Med Surg,2018,8(5):480-490.
[7]武国军.X线胸片和CT扫描在中央型肺癌诊断中的应用对比分析[J].临床医学研究与实践,2017,2(1):13-14.
[8]赵拴来.胸片与CT检查在周围型肺癌中的应用效果探析[J].中国辐射卫生,2016,25(4):502-503.
[9]Lowenstein L M,Deyter G M R,Nishi S,et al.Shared decision-making conversations and smoking cessation interventions:critical components of low-dose CT lung cancer screening programs[J].Transl Lung Cancer Res,2018,7(3):254-271.
[10]Pinsky P F.Lung cancer screening with low-dose CT:a world-wide view[J].Transl Lung Cancer Res,2018,7(3):234-242.
[11]Takahashi E A,Koo C W,White D B,et al.Prospective Pilot Evaluation of Radiologists and Computer-aided Pulmonary Nodule Detection on Ultra-low-Dose CT With Tin Filtration[J].JThorac Imaging,2018,33(6):396-401.
[12]刘玉萍,冯刚.体检人群低剂量CT早期肺癌筛查结果及危险因素分析[J].中华老年医学杂志,2017,24(11):1242-1246.
[13]高忠嵩,叶兆祥,张鹏,等.天津地区低剂量CT肺癌基线筛查与随访的初步临床分析[J].中国肿瘤临床,2017,44(20):1034-1039.
[14]马艳.低剂量CT扫描对肺部小结节的诊断价值[J].中国民康医学,2018,30(1):100-101.
[15]李捷.常规剂量和低剂量CT扫描诊断肺结节的意义探析[J].中国继续医学教育,2018,10(7):49-51.
[16]孙琦,黄遥,赵世俊,等.低剂量CT肺癌筛查中持续存在肺结节的CT体积和质量增长及其影响因素[J].中华肿瘤杂志,2018,25(4):274-279.
[17]徐红卫.低剂量CT在肺癌术后短期复查中的应用价值[J].现代诊断与治疗,2017,28(13):2502-2503.
[18]纪颖,薛迪.低剂量CT用于肺癌筛查的Meta分析[J].实用癌症杂志,2017,33(8):1283-1287.
[19]孟善进.低剂量CT在筛查及鉴别疑似肺癌患者中的应用[J].湖南师范大学学报:医学版,2017,19(6):181-185.