Evaluation of screening-detected lung nodules: minimising the risk of unnecessary biopsy and surgery.

摘要

Screening for lung cancer has a long and controversial history. Successful screening is predicated on two fundamental principles. First, the screening test should be able to detect disease in an early preclinical phase before symptoms develop. Second, treatment should be available and more effective when provided during the preclinical phase. On the surface it would appear that screening for lung cancer passes both of these tests, given our experience with treating 'early' versus 'late' stage lung cancer that is clinically detected. However, if we acknowledge that at least some cases of clinically detected stage I and II lung cancer might represent disease that is relatively indolent biologically as opposed to 'early', then the possibility exists that early detection will not alter the natural history of lung cancer and result in more frequent cure. Fortunately, the hypothesis that lung cancer screening with CT scanning reduces mortality is currently being evaluated in several large randomised controlled trials in both the USA and Europe.