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首页> 外文期刊>Seminars in Respiratory and Critical Care Medicine >Screening for Lung Cancer in High-Risk Groups:Current Status of Low-Dose Spiral CT Scanning and Sputum Markers
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Screening for Lung Cancer in High-Risk Groups:Current Status of Low-Dose Spiral CT Scanning and Sputum Markers

机译：高危人群肺癌筛查：低剂量螺旋CT扫描和痰液标记物的现状

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Lung cancer is the number one cause of death from cancer in the United States. Currently, there is no official recommendation to screen for lung cancer even in high-risk populations. Accordingly, we wait for patients to present with symptoms. Only 15-20% of patients are stage I lung cancer at diagnosis. Past screening trials with chest roentgenogram and sputum cytology did not show a reduction of lung cancer mortality in the screened population. Since the completion of those trials in the early 1980s we have learned that the chest X ray is not sensitive at detecting lesions < 2 cm in size, and patients with chronic obstructive pulmonary disease (COPD) have a 4- to 6-fold increased risk of lung cancer independent of their smoking history. Recent trials with spiral computed tomography (CT) scan screening have detected 80-85% of lung cancers while they are stage I. The problems related to spiral CT screening are the cost and the frequent detection of benign lesions. Algorithms are being developed to try and prevent unnecessary biopsies and/or surgery. Sputum cytology is currently the only clinically approved sputum test for detecting lung cancer. However, in patients with moderate dysplasia of cytology, the LIFE autofluorescence bronchoscopy system may yield an increased sensitivity of detecting precancerous or cancerous lesions. More studies are needed before the LIFE system can be adopted as a standard clinical tool. Currently, investigators are evaluating the sputum for early lung cancer detection markers. The marker that is the most developed is the monoclonal antibody to the heterogeneous nuclear ribonucleoprotein A2/B1 on the sputum epithelial cell surface. Encouraging preliminary results have been reported and trials are ongoing. The future looks bright for the field of lung cancer screening.
机译：肺癌是美国癌症的第一大死因。当前，即使在高风险人群中也没有官方推荐的筛查肺癌的方法。因此，我们等待患者出现症状。诊断时只有15-20％的患者为I期肺癌。过去的胸部X线照片和痰细胞学筛查试验并未显示出筛查人群的肺癌死亡率降低。自1980年代初期完成这些试验以来，我们了解到，胸部X射线对检测小于2 cm的病变并不敏感，患有慢性阻塞性肺疾病（COPD）的患者的风险增加了4到6倍与吸烟史无关的肺癌。螺旋CT（CT）扫描筛查的最新试验已检测出80％至85％的肺癌处于I期。与螺旋CT筛查有关的问题是成本和良性病变的频繁检测。正在开发算法以尝试和防止不必要的活检和/或手术。痰细胞学检查是目前唯一可用于肺癌的临床痰检查方法。但是，在中度细胞学异常增生的患者中，LIFE自体荧光支气管镜检查系统可能会提高检测癌前病变或癌性病变的敏感性。在将LIFE系统用作标准临床工具之前，需要进行更多的研究。目前，研究人员正在评估痰液中早期肺癌的检测指标。最发达的标记是针对痰上皮细胞表面异质核糖核糖核蛋白A2 / B1的单克隆抗体。已经报告了令人鼓舞的初步结果，并且正在进行试验。肺癌筛查领域的前途一片光明。

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