Screening des Lungenkarzinoms: Stand 2007

ZusammenfassungÜberlegungen zum Screening des Lungenkarzinoms werden motiviert durch die sehr schlechte Prognose des Tumors bei Diagnose aufgrund von Symptomen (<15% 5-Jahres-Überleben), die deutlich bessere Prognose asymptomatischer früher Stadien (bis 80% 5-Jahres-Überleben), die hohe Sensitivität der nativen Niedrigdosis-CT für kleine Tumoren und die gute Identifizierbarkeit von Risikopersonen.Machbarkeitsstudien unter Verwendung genau definierter diagnostischer Algorithmen zum Umgang mit gefundenen Lungenrundherden zeigten einen großen Anteil (>50 bis >90%) kleiner, resektabler nichtkleinzelliger Lungenkarzinome in frühen Stadien mit guter Prognose der betroffenen Patienten bei einer geringen Rate unnötiger Biopsien. Da allerdings Verzerrungsfaktoren wie Überdiagnose, length-time und lead-time Aussagen zum tatsächlichen Nutzen der Methode hinsichtlich einer Senkung der Sterblichkeit am Lungenkarzinom nicht zulassen, werden derzeit die Ergebnisse großer prospektiver randomisierter Studien abgewartet.Gleichzeitig sind andere Früherkennungsmethoden wie verfeinerte Sputumdiagnostik, Analyse molekularer Marker im Blut oder Atemluftanalyse in der Evaluation.AbstractThoughts on screening for lung cancer are based on the very poor prognosis of this tumor when the diagnosis is made because of symptoms (<15% 5-year survival), the markedly better prognosis if it is detected in asymptomatic early stages (up to 80% 5-year survival), the high sensitivity of unenhanced low-dose CT in the detection of small tumors, and the clear definition of persons at risk.Feasibility studies using well-defined diagnostic algorithms for management of detected pulmonary nodules have demonstrated a high proportion (>50 to >90%) of small, resectable non-small-cell lung carcinomas in the early stages, with a good prognosis for the patients affected and a low rate of unnecessary biopsies. However, biases such as overdiagnosis, length-time and lead-time could hamper potential reduction of mortality from lung cancer, and the results of large prospective randomized trials are therefore awaited.At the same time, other techniques for early diagnosis of lung cancer are under evaluation, such as sophisticated methods of sputum analysis, molecular markers in the blood and analysis of exhaled air.

[1]  W. Heindel,et al.  Radiologisches Screening des Bronchialkarzinoms: Aktueller Stand und zukünftige Perspektiven1 , 2001 .

[2]  Hironobu Ohmatsu,et al.  Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  F. Fazio,et al.  Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results , 2003, The Lancet.

[4]  S. Swensen,et al.  Lung cancer screening with CT: Mayo Clinic experience. , 2003, Radiology.

[5]  O. Miettinen,et al.  Survival of Patients with Stage I Lung Cancer Detected on CT Screening , 2008 .

[6]  S Sone,et al.  Growth rate of small lung cancers detected on mass CT screening. , 2000, The British journal of radiology.

[7]  C. Mountain,et al.  Revisions in the International System for Staging Lung Cancer. , 1997, Chest.

[8]  P. Mazzone,et al.  Detection of lung cancer by sensor array analyses of exhaled breath. , 2005, American journal of respiratory and critical care medicine.

[9]  W. Heindel,et al.  Lungenkrebsfrüherkennung mit Low-dose-CT: ein Update , 2002, Der Radiologe.

[10]  W. Heindel,et al.  Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. , 2002, Radiology.

[11]  B J Flehinger,et al.  Screening for early lung cancer. Results of the Memorial Sloan-Kettering study in New York. , 1984, Chest.

[12]  W. Heindel,et al.  Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers , 2004, European Radiology.

[13]  W. C. Ball,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. , 2015, The American review of respiratory disease.

[14]  Feng Li,et al.  Mass screening for lung cancer with mobile spiral computed tomography scanner , 1998, The Lancet.

[15]  Stefan Diederich,et al.  Screening for early lung cancer with low-dose spiral computed tomography , 2003, The Lancet.

[16]  D. Eddy,et al.  Screening for lung cancer. , 1989, Annals of internal medicine.

[17]  Mark Tann,et al.  Volumetric growth rate of stage I lung cancer prior to treatment: serial CT scanning. , 2002, Radiology.

[18]  Bronchialkarzinom-Screening mit Niedrigdosis-CT Aktueller Stand , 2001, Der Radiologe.

[19]  W F Taylor,et al.  Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. , 2015, The American review of respiratory disease.

[20]  S. Sone,et al.  Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner , 2001, British Journal of Cancer.

[21]  O. Miettinen,et al.  Early Lung Cancer Action Project: overall design and findings from baseline screening , 1999, The Lancet.

[22]  H Lenzen,et al.  Radiation exposure associated with imaging of the chest , 2000, Cancer.

[23]  O S Miettinen,et al.  Early Lung Cancer Action Project , 2001, Cancer.

[24]  J Polák,et al.  Lung cancer detection results of a randomized prospective study in Czechoslovakia , 1986, Cancer.

[25]  Anne-Marie Sykes,et al.  CT screening for lung cancer: five-year prospective experience. , 2005, Radiology.

[26]  Hajime Nakata,et al.  Lung cancer screening using low-dose spiral CT: results of baseline and 1-year follow-up studies. , 2002, Chest.

[27]  S. Swensen,et al.  Screening for lung cancer with low-dose spiral computed tomography. , 2000, American journal of respiratory and critical care medicine.

[28]  H. Ohmatsu,et al.  Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. , 1996, Radiology.