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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-0653

摘要内容如下：

背景

使用低剂量计算机断层扫描（LDCT）的肺癌筛查（LCS）可降低肺癌死亡率，但可能导致下游程序、并发症和其他潜在危害。NLST（国家肺部筛查试验）以外的这些事件的估计是可变的，并且缺乏筛查结果的评估，这允许与试验进行更直接的比较。

目的

确定与LC相关的下游手术和并发症的发生率。

设计

回顾性队列研究。

设置

5美国医疗保健系统。

病人

在2014年至2018年期间完成LCS基线LDCT扫描的个人。

测量

结果包括下游成像、侵入性诊断程序和操作并发症。根据筛查结果和肺癌检测结果计算总体和分层的绝对率，并计算阳性和阴性预测值。

结果

在9266例筛查患者中，1472例（15.9%）的基线LDCT扫描显示异常，其中140例（9.5%）在12个月内诊断为肺癌（阳性预测值，9.5%[95%CI，8.0%-11.0%]；阴性预测值，99.8%[CI，99.7%至99.9%]；敏感性，92.7%[CI，88.6%至96.9%]；特异性，84.4%[CI，83.7%至85.2%]）。在筛查的患者中，下游成像和侵入性操作的绝对比率分别为31.9%和2.8%。在异常发现后接受侵入性操作的患者中，并发症发生率显著高于NLST（30.6%对17.7%的任何并发症；20.6%对9.4%的严重并发症）。

局限性

对结果的评估是回顾性的，并基于程序编码。

结论

结果表明，与NLST中观察到的相比，实践中与LCS相关的下游手术和并发症的发生率明显更高。可能需要评估和改进诊断管理，以确保筛查的益处大于潜在的危害。

英文原文如下：

Abstracts

BACKGROUND  Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces lung cancer mortality but can lead to downstream procedures, complications, and other potential harms. Estimates of these events outside NLST (National Lung Screening Trial) have been variable and lacked evaluation by screening result, which allows more direct comparison with trials.

OBJECTIVE  To identify rates of downstream procedures and complications associated with LCS.

DESIGN  Retrospective cohort study.

SETTING  5 U.S. health care systems.

PATIENTS  Individuals who completed a baseline LDCT scan for LCS between 2014 and 2018.

MEASUREMENTS  Outcomes included downstream imaging, invasive diagnostic procedures, and procedural complications. For each, absolute rates were calculated overall and stratified by screening result and by lung cancer detection, and positive and negative predictive values were calculated.

RESULTS  Among the 9266 screened patients, 1472 (15.9%) had a baseline LDCT scan showing abnormalities, of whom 140 (9.5%) were diagnosed with lung cancer within 12 months (positive predictive value, 9.5% [95% CI, 8.0% to 11.0%]; negative predictive value, 99.8% [CI, 99.7% to 99.9%]; sensitivity, 92.7% [CI, 88.6% to 96.9%]; specificity, 84.4% [CI, 83.7% to 85.2%]). Absolute rates of downstream imaging and invasive procedures in screened patients were 31.9% and 2.8%, respectively. In patients undergoing invasive procedures after abnormal findings, complication rates were substantially higher than those in NLST (30.6% vs. 17.7% for any complication; 20.6% vs. 9.4% for major complications).

LIMITATION  Assessment of outcomes was retrospective and was based on procedural coding.

CONCLUSION  The results indicate substantially higher rates of downstream procedures and complications associated with LCS in practice than observed in NLST. Diagnostic management likely needs to be assessed and improved to ensure that screening benefits outweigh potential harms.

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