背景:低剂量胸部CT筛查肺癌已成为美国的护理标准,在很大程度上是因为国家肺部筛查试验(NLST)的结果。其他证据支持低剂量胸部CT筛查肺癌的净益处,并增加了减少潜在危害的经验,自从这些准则的前一次迭代以来已经积累了。这里,我们更新了福利的证据库,危害,并实施低剂量胸部CT筛查。我们使用更新的证据库在证据允许的情况下提供建议,以及基于经验和专家共识的声明。
方法:批准的小组成员使用人口审查了以前开发的关键问题,干预,比较器,解决低剂量CT筛查的益处和危害的结果格式,和计划实施的关键领域。通过PubMed使用MEDLINE进行了系统的文献综述,Embase,和Cochrane图书馆自上次指南发布以来每季度一次。检索了相关检索的参考列表,并添加了其他论文。两名小组成员对检索到的参考文献进行了相关性审查。使用建议分级评估每个关键或重要结果的证据质量,评估,发展,和评价方法。在有足够证据的情况下进行Meta分析。根据系统文献综述的证据,解决了重要的临床问题。起草了分级建议和未分级声明,投票,并修改,直到达成共识。
结果:系统文献综述确定了75项额外的研究,这些研究对所开发的12个关键问题做出了回应。解决了其他临床问题,得出了7项分级建议和9项未分级共识声明。
结论:证据表明,低剂量CT筛查肺癌可以带来有利的利弊平衡。筛选符合条件的个人,成像和图像解释的质量,屏幕检测结果的管理,戒烟干预措施的有效性会影响这种平衡。
Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not.
Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analyses were performed when enough evidence was available. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached.
The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements.
Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance.