肺癌筛查中偶然发现的结构化分诊：英国项目的结局
Structured triage of incidental findings in lung cancer screening: Outcomes from a UK programme.
作者
作者单位
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK; Division of Medicine, University of Nottingham, Nottingham NG5 1PB, UK. Electronic address: amna.burzic@nhs.net.
- Department of Respiratory Medicine, Nottingham City Hospital, Nottingham, UK; Division of Medicine, University of Nottingham, Nottingham NG5 1PB, UK.
- Division of Medicine, University of Nottingham, Nottingham NG5 1PB, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
摘要
中文
低剂量CT（LDCT）肺癌筛查常发现偶然发现（IFs）。这些发现可能对受试者有益或有害，需有效管理。我们评估了真实世界筛查项目中IFs的结构化分诊是否带来有意义的临床行动或获益。我们回顾性审查了2023年1月至2025年5月期间按照国家方案转诊的IFs。结局包括无需进一步处理、检查、转诊、监测和/或治疗。额外详细分析评估了中重度冠状动脉钙化（CAC）的管理和早期结局。在15,465次LDCT扫描中，1,030名受试者中的1,049个IFs被转诊并接受服务审查（占所有LDCT的6.8%）。37%在审查后无需处理；23%需要单项检查。292个（27.8%）导致新诊断；51名受试者（4.9%）接受药物治疗，15名（1.4%）接受手术。检测到63例偶发性癌症，其中63.5%接受了根治性治疗。常见IFs包括主动脉瓣钙化（21.0%）、胸主动脉扩张（10.0%）和肾脏异常（9.9%）。在904名中重度CAC受试者中，220名基线未接受降脂治疗。其中，仅35%在两年内开始治疗。该组两年全因死亡率为4.7%，三分之一死于心血管原因。结构化分诊可实现一致、相称的IF管理。大多数IFs无需持续随访，少数导致诊断和干预。CAC常见且治疗不足，突出了应纳入肺癌筛查路径的可修饰竞争风险。
English
Low-dose CT (LDCT) lung cancer screening frequently identifies incidental findings (IFs). These have the potential to be beneficial or harmful to the participant and need to be managed effectively. We evaluated whether structured triage of IFs in a real-world screening programme led to meaningful clinical actions or benefit. We retrospectively reviewed IFs referred according to the national protocol between January 2023 and May 2025. Outcomes included no further action, investigation, referral, surveillance, and/or treatment. Additional detailed analysis evaluated management and early outcomes of moderate or severe coronary artery calcification (CAC). Of 15,465 LDCT scans, 1,049 IFs in 1,030 participants were referred and reviewed by the service (6.8% of total LDCTs). Thirty-seven percent required no action after review; 23% required a single investigation. 292 (27.8%) led to new diagnoses; 51 participants (4.9%) received medical treatment, and 15 (1.4%) underwent surgery. Sixty-three incidental cancers were detected, of which 63.5% received radical treatment. Common IFs included aortic valve calcification (21.0%), thoracic aortic dilatation (10.0%), and renal abnormalities (9.9%). Among 904 participants with moderate or severe CAC, 220 were not on lipid-lowering therapy at baseline. Of these, only 35% initiated treatment within two years. All-cause mortality in this group was 4.7% at two years, with one-third due to cardiovascular causes. Structured triage enables consistent, proportionate IF management. Most IFs required no ongoing follow-up, while a minority led to diagnosis and intervention. CAC was common and undertreated, highlighting a modifiable competing risk that should be integrated into lung cancer screening pathways.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 5.3
- 新锐分区
- 2区