저선량 CT를 이용한 폐암의 선별 검사

Lung Cancer Screening with Low-dose Computed Tomography

  • 황정화 (순천향대학교 의과대학 진단방사선과학교실)
  • Hwang, Jung Hwa (Department of Radiology Soonchunhyang University Hospital)
  • 발행 : 2004.08.30

초록

Lung cancer is the leading cause of cancer death for men and women in the industrialized world. It is desirable to detect disease at a stage when it is not causing symptoms and when control or cure is possible. If the screening test detects patients with the disease at an early stage, they can be examined to confirm the diagnosis and intervention can alter the natural history of the disease. The results of screening programs designed to detect early lung cancer using either conventional chest radiograph or sputum cytology are disappointing for a diagnostic screening test. Because of advances in helical CT imaging techniques, screening for lung cancer has been suggested as a possible method of improving outcome. Findings in recent publications suggest that substantial dose reduction is possible in chest CT. The advantages of low-dose CT are more sensitive than chest radiograph for detecting small pulmonary nodules that may be lung cancers, shorter scanning time than conventional chest CT scan without intravenous contrast injection, cheaper cost than standard CT, low radiation dose. However, the true clinical significance of the small tumors found by screening is still unknown, and their effect on mortality awaits future investigation. Furthermore, in addition to detecting an increased number of lung cancers, low-dose CT found at least one indeterminate nodule in many of all screened patients. The majority should be benign but evaluation of all these indeterminate nodules is not a trivial problem in routine practice. In conclusion, lung cancer screening with low-dose CT is a complex subject. The true effectiveness of lung cancer screening (a reduction in mortality from lung cancer) with low-dose CT can be determined through well-designed randomized control trials with enrolment of appropriate subjects.

키워드

참고문헌

  1. Greenlee RT, Murray T, Bolden S wingo PA. Cancer statistics, 2000. CA Cancer J Clin 2000;50:7-33
  2. Lee C-T. Epidemiology of lung cancer in Korea. Cancer Research and Treatment 2002;34(1):3-7
  3. Aberle DR, Gamsu G, Henschke CI, Naidich DP, Swensen SJ. A Consensus Statement of the Society of Thoracic Radiology: Screening for Lung Cancer withHelical Computed Tomography. J Thorac Imaging 2001;16:65-68
  4. Fry WA, Menck HR, Winchester DP. The National Cancer Data Base report on lung cancer. Cancer 1996;77:1947-55
  5. Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997;111:1710-17
  6. Flehinger BJ, Kimmel M, Melamed MR. The effect of surgical treatment on survival from early lung cancer. Chest 1992;101:1013-18
  7. Mountain CF. Prognostic implications of the international staging system for lung cancer. Semin Oncol 1988;15:236-45
  8. Inoue K, Sato M, Fujimura S, Sakurada A, Takahashi S, Usuda K, et al. Prognostic assessment of 1310 patients with non-small cell lung cancer who underwent complete resection from 1980 to 1993. J Thorac Cardiovasc Surg 1998;116:407-11
  9. Nesbitt JC, Putnam JB Jr., Walsh GL, Roth JA, Mountain CF. Survival in early-stage non-small cell lung cancer. Ann Thorac Surg 1995;60:466-72
  10. Jassem J, Skokowski J, Dziadziuszko R, Jassem E, Szymonowska A, Rzyman W, et al. Results of surgical treatment of non-small cell lung cancer: validation ofthe new postoperative pathological TNM classification. J Thorac Cardiovasc Surg 2000;119: 1141-6
  11. Patz EF Jr, Rossi S, Harpole DH Jr Herrdon JE,Goodman PC, et al. Correlation of tumor size and survival in patients with Stage IA non-small cell lung cancer. Chest 2000;117:1568-71
  12. Hulka BS. Cancer screening degrees of proof and practical application. Cancer 1988;62(8 Suppl)1776-80
  13. Black WC, Welch HG. Screening for disease. AJR Am J Roentgenol 1997;168:3-11
  14. Weiss W, Boucot KR. The Philadelphia Pulmonary Neoplasm Research Project: early roentgenographic appearance of bronchogenic carcinoma. Arch Intern Med 1974;134:306-11
  15. An evaluation of radiologic and cytologic screening for the early detection of lung cancer: a cooperative pilot study of the American Cancer Society and the Veterans Administration. Cancer Res 1966;26:2083-121
  16. Hayata Y, Funatsu H, Kato H, Saito Y, Sawamura K, Furose K. Results of lung cancer screening programs in Japan. Recent Results Cancer Res. 1982;82:163-73
  17. Nash FA, Morgan JM, Tomkins JG. South London Lung Cancer Study. Br Med J 1968;2:715-21
  18. Frost JK, Ball WC Jr, Levin ML. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis 1984;130:549-54
  19. Flehinger BJ, Melamed MR, Zaman MB, Jeelan RT, Perchick WB Martini N. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Ketterring study. Am Rev Respir Dis 1984; 130:555-60
  20. Fontana RS, Sanderson DR, Taylor WF, woolner LB, Miller WE, Muhm JR, Uhlenhopp MA. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic Study. Am Rev Respir Dis 1984;130:561-5
  21. Tockman MS. Survival ad mortality from lung cancer in a screened population: The Johns Hopkins study. Chest 1986;89:324s-5s
  22. Kubik A, Polak J. Lung cancer detection. Results of a randomized prospective study in Czechoslovakia. Cancer 1986;57:2427-37
  23. Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Muhm JR, et al. Screening for lung cancer. A critique of the Mayo lung project. Cancer 1991;67:1155-64
  24. Strauss GM, Gleason RE, Sugarbaker DJ. Chest xray screening improves outcome in lung cancer. A reappraisal of randomized trials on lung cancer screening. Chest 1995;107:270s-9s
  25. Strauss GM, Gleason RE, Sugarbaker DJ. Screening for lung cancer. Another look; a different view. Chest 1997;111:754-68
  26. Kaneko M, Eguchi K, Ohmatsu H, kukinuma R, Naruke T, Suemusu k, et al. Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 1996;201: 798-802
  27. Sone S, Takashima S, Li F, Jang Z, Honda T, Maruyama Y, et al. Mass screening for lung cancer with mobile spiral computed tomography scanner.Lancet 1998;351:1242-5
  28. Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, Mcguinness G, Miettinen OS et al. Early lung cancer action project: overall design and findings from baseline screening. Lancet 1999;354: 99-105
  29. Swenson SJ. Lung cancer screening: low-dose CT. Presented at the Society of Thoracic Radiology Meeting, San Diego, CA., March 12-16, 2000