胸部低剂量CT在早期肺癌筛查中的应用研究

发布时间：2018-01-19 10:11

本文关键词： 肺癌筛查低剂量 X线计算机女性肺结节筛查低剂量年龄吸烟指数　出处：《北京协和医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的报道中国医学科学院肿瘤医院4690例无症状受检者肺癌LDCT筛查结果。方法签署知情同意书后,4690名年龄在40岁及以上的无症状体检者接受LDCT检查。根据NCCN标准(version 2.2014)将筛查人群分为高、中、低危三组,并根据性别、吸烟史及二手烟接触史分为女性和男性非吸烟者二手烟暴露组。扫描方案、诊断及随访标准参照I-ELCAP。所有实性/部分实性结节≥5mm或非实性结节≥8mm判断为阳性结节,提出随诊方案或进一步医学检查,并按计划随访观察结节大小变化。TNM分期以临床证据及病理诊断为标准。结果三组LDCT检查阳性率分别为27.0%(86/319),19.3%(199/1029)和11.3%(377/3342)。26名受检者中检出肺癌27灶,通过手术病理证实23例(24灶)非小细胞肺癌中早期肺癌19灶,早诊率76.0%。高、中、低危三组肺癌检出率无统计学差异(P=0.054)。肿瘤大小6.9-29.5mm(中位值16.3mm)。对于40岁或以上非吸烟有二手烟接触史女性,恶性结节检出率在阳性结节病例中的比例与高危组比较差异有统计学意义(7.19% vs.2.94%,P=0.002)。结论LDCT适用于对无症状健康人群进行肺癌筛查,肺癌检出率为0.6%,早期肺癌检出率高,达76.0%。应充分重视对中国40岁以上有二手烟接触史的女性非吸烟者的早期肺癌筛查的相关研究。目的：评估早期肺癌筛查LDCT肺结节的检出与受检者年龄、吸烟状态与吸烟量的关系。材料及方法：2008年7月-2012年6月间在中国医学科学院肿瘤医院影像诊断科行早期肺癌筛查基线LDCT检查,年龄≥40岁并详细填写年龄、吸烟状态及每日吸烟量及吸烟年数的受检者,共3363例纳入本研究。根据年龄分为5组：40-49岁、50-59岁、60-69岁、70-79岁和80-89岁共5组；根据吸烟状态及吸烟量分为4组：非吸烟者、轻度吸烟者(吸烟指数SI20)、重度吸烟者(20≤SI30)和极重度吸烟者(SI≥30)。LDCT结果依据I-ELCAP结节随访流程进行。分析不同年龄组、不同吸烟状态组的肺内结节检出情况、肺内阳性结节检出情况,并分析年龄与吸烟状态与肺结节检出的相关性。结果：2295例受检者(68.2%)基线LDCT至少检出一枚肺内非钙化结节。不同年龄组中肺内结节检出率为64.1%(40-49岁)、71.4%(50-59岁)、74.7%(60-69岁)、76.0%(70-79岁)、66.7%(80-89岁),其中50-79岁三组检出率明显高于40-49岁组和80-89岁组,差异有统计学意义(P0.001)。不同吸烟状态组肺内结节检出率分别为67.7%(非吸烟组)、68.7%(轻度吸烟组)、65.8%(重度吸烟组)、71.4%(极重度吸烟组),极重度吸烟组肺内结节检出率最高,但各组差异无统计学意义(P=-0.269)。肺内非钙化结节检出数量、结节大小与受检者年龄、吸烟指数呈正相关(0.110/0.111、0.115/0.048)。556例受检者至少检出1枚阳性结节。不同年龄组中阳性结节检出率为11.9%、17.9%、25.1%、37.6%、25.0%。40-79岁组中,阳性结节检出率明显上升,组间差异均有统计学意义(P0.001)。不同吸烟状态组阳性结节检出率为16.1%、14.3%、13.7%、22.8%,极重度吸烟组阳性结节检出率最高,较其它3组差异有统计学意义(P0.001)。25例受检者中检出恶性结节(0.7%),恶性结节在不同年龄组中的检出率分别为：0.5%、0.7%、0.9%、4.0%,其中70-79岁组较其它3个年龄组明显增高,且差异有统计学意义(P0.001)。恶性结节在不同吸烟状态组中的检出率分别为1.0%、0.1%、0.7%和0.7%,非吸烟组较吸烟组高(1.0% vs.0.5%),各吸烟组间差异无统计学意义。70-79岁组检出肺内结节大小(4.5±3.6mm)、肺内阳性结节大小(9.7±5.7mm)及恶性结节大小(18.3±6.8mm)均较其它3组为大,且差异有统计学意义(P0.001)。结论：LDCT肺内结节及阳性结节检出率随受检者年龄的增长、吸烟指数增高而增长。LDCT肺内结节及阳性结节的检出数量及结节大小与年龄及吸烟指数呈正相关。肺内恶性结节检出率与受检者年龄呈正相关,与吸烟指数关系不大。
[Abstract]:Objective to report the tumor hospital of Chinese Academy of Medical Sciences in 4690 asymptomatic subjects with lung cancer screening results. Methods LDCT signed informed consent, at the age of 4690 asymptomatic subjects aged 40 years and above the accepted LDCT examination. According to the NCCN standard (version 2.2014) will be screened were divided into high, low risk group three. According to gender, smoking and secondhand smoke exposure is divided into male and female non smokers exposed to secondhand smoke. Scanning scheme, the diagnosis and follow-up of I-ELCAP. reference standard of all solid / solid nodules larger than 5mm or non solid nodules larger than 8mm was judged as positive node, put forward the follow-up plan or further medical examination. According to the plan and follow-up observation of nodule size changes of.TNM staging with clinical evidence and pathological diagnosis standard. Results the positive rate of the three groups of LDCT examination were 27% (86/319), 19.3% (199/1029) and 11.3% (377/3342).26 subjects were detected in 27 lung cancer Through the lesions, 23 cases were confirmed by surgical pathology (24 lesions) of non-small cell lung cancer in early stage lung cancer 19 foci, early diagnosis rate of 76.0%. is high, low risk group, three lung cancer detection rate showed no significant difference (P=0.054). The tumor size 6.9-29.5mm (median 16.3mm). For 40 years or more non smoking second-hand smoke contact history of female malignant nodules detection rate in the case of positive nodules and the proportion of high-risk group had significant difference (7.19% vs.2.94%, P=0.002). Conclusion LDCT is suitable for screening for lung cancer in asymptomatic healthy population, lung cancer detection rate was 0.6%. The detection rate of early lung cancer, 76.0%. should pay full attention to the related research on Chinese over the age of 40 years of second-hand smoke exposure history of female non smokers early lung cancer screening. Objective: To evaluate the early lung cancer screening LDCT Pulmonary Nodules Detection and patient age, the relationship between smoking status and smoking. Materials and methods: -201 July 2008 2 year in June in the cancer hospital Chinese Academy of Medical Sciences for early lung cancer screening LDCT baseline examination, 40 years of age or older and fill in the age of subjects and the amount of smoking status and daily smoking, the number of years, a total of 3363 cases were included in this study. According to the age were divided into 5 groups: 40-49, 50-59 the age, 60-69 years, 70-79 years and 80-89 years old were divided into 5 groups according to smoking status and smoking; divided into 4 groups: non smokers, mild smokers (smoking index SI20), heavy smokers (20 SI30) and heavy smokers (SI = 30).LDCT I-ELCAP according to the results of follow-up process. Analysis of nodules of different ages group, pulmonary nodule detection in different smoking status group, lung nodules were positive, and positive correlation analysis between age and smoking status and pulmonary nodules. Results: 2295 subjects (68.2%) at least a baseline LDCT detection of pulmonary non calcified nodules. In the age group of pulmonary nodules detection rate was 64.1% (40-49 years), 71.4% (50-59 years), 74.7% (60-69 years), 76% (70-79 years), 66.7% (80-89 years), of which 50-79 years the detection rate of the three groups were significantly higher than that of 40-49 years and 80-89 years age group, the difference was statistically significant (P0.001). With the smoking status group pulmonary nodules detection rate was 67.7% (non smoking group), 68.7% (mild smoking group), 65.8% (severe smoking group), 71.4% (severe smoking group, smoking group) with severe pulmonary nodules detection rate is the highest, but no significant difference between groups (P=, -0.269). The lungs of non calcified nodules the number of detected nodules, and patient age, smoking index was positively correlated with.556 (0.110/0.111,0.115/0.048) subjects at least 1 positive nodes. The detection of different age groups in the positive nodules detection rate was 11.9%, 17.9%, 25.1%, 37.6%, 25 in the%.40-79 group, the positive nodules detection rate increased significantly, the differences were between groups Statistical significance (P0.001). Different smoking status group positive nodules detection rate was 16.1%, 14.3%, 13.7%, 22.8%, severe smoking group positive nodules detection rate was statistically significant compared with the other 3 groups (P0.001) of malignant nodules.25 subjects (0.7%), the rate for malignant nodules in different age groups: 0.5%, 0.7%, 0.9%, 4%, 70-79 years old group than the other 3 age groups were significantly increased, and the difference was statistically significant (P0.001). The detection rate was 1%, malignant nodules in different smoking status in the group of 0.1%, 0.7% and 0.7%, non smoking group and smoking group high (1% vs.0.5%), the difference between the smoking group was not statistically significant.70-79 age group detected pulmonary nodule size (4.5 + 3.6mm), positive pulmonary nodules (9.7 + 5.7mm) and malignant nodules (18.3 + 6.8mm) were lower than the other 3 groups, and the difference was statistically significant (P0.001). Conclusion: LDCT lung In the positive detection rate of nodules and nodules with subject age, smoking index increased and the number of nodule size was positively detected with age and smoking index and growth of.LDCT pulmonary nodules and positive nodules. The detection rate of malignant lung nodules and the subjects age was positively correlated with smoking index has little relationship.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R734.2;R730.44

【相似文献】