[专家视点] 史美祺：CT扫描是否适用于常规肺癌筛查？
编者按： 作为全球第一大肿瘤，肺癌的发病率和死亡率不断上升，主要原因是诊断时疾病已到晚期，因此，肺癌的预防和早期筛查成为降低其发病率和死亡率的关键。2013年，有报道称部分高危个体可采用小剂量CT扫描进行肺癌筛查。但是，CT筛查的假阳性结果率较高，为了促进大家对此项研究的理解，肿瘤评论特邀请江苏省肿瘤医院肿瘤内科主任医师史美祺教授对此进行了解析。
点评：2013年，ASCO报道了NLST研究的阳性结果，高危病人的早期筛查对发现早期肺癌有益处，各种指南也加以广泛推荐，国内各种学术活动也广为传播，强调早期筛查的重要性。本篇文章提出了反对的意见，值得大家思考，在国内现有条件下，我们是否也应该冷静想想？
推荐文章
医疗小组投票反对用CT扫描来筛查肺癌
Modern Healthcare(5/1, Dickson, Subscription Publication, 224K)报告称：“一个医疗小组认为，没有足够的证据证明年度CT扫描可用于重度吸烟者的早期肺癌检测”。这一“预想不到的不具约束力的建议，违背了去年由美国预防服务工作组的推荐，即年龄在55〜80岁之间的目前或过去的重度吸烟者应该进行扫描。”根据Modern Healthcare，“医疗保险委员会的职责是建议医疗保险和医疗救助服务中心（CMS）的承保范围，该委员会表示，他们对医疗保险受益人定期扫描的获益大于心理创伤或不必要的手术可能导致误报的风险几乎没有信心。”
Congressional Quarterly(5/1, Young, Subscription Publication, 967)报道称，该决定“对一直致力于推动联邦政府为老年人扫描提供健康保险支付的集团予以沉重的打击”。
MedPage Today (5/1, Phend, 205K)指出，NLST研究中发现，在27%的阳性扫描结果中假阳性率为96%，这吸引了大家的关注。”然而, 密歇根大学心胸放射科主任、美国放射协会代表Ella Kazerooni博士辩称, “LUNGRADS结构化报告和管理体系标准应该帮助解决这个问题”。 Kazerooni博士称这一标准将降低假阳性率至10%，但是缺乏可见数据的支持，故难以使小组成员对此确信。
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英文原文
Medicare Panel Votes Against CT Scans For Lung Cancer Screening.
Modern Healthcare (5/1, Dickson, Subscription Publication, 224K) reports that “a Medicare panel determined that there is not enough evidence to justify annual CT scans to detect early lung cancer in heavy smokers.” This “unexpected decision on the nonbinding recommendation runs counter to a...recommendation” last year “by the U.S. Preventive Services Task Force that current or past heavy smokers ages 55 to 80 should get the scans.” According to Modern Healthcare, “The members of the Medicare committee, which advises CMS（Centers for Medicare & Medicaid Services (CMS)） on coverage determinations, indicated that they had little confidence that the benefits of subjecting Medicare beneficiaries to regular scans outweighed the risks of the psychological trauma or unnecessary surgeries that could result from false positives.”
Congressional Quarterly(5/1, Young, Subscription Publication, 967)(5/1, Young, Subscription Publication, 967) reports that the decision “dealt a blow to groups that have been pushing to get the federal health plan for the elderly to pay for” the scans.
MedPage Today (5/1, Phend, 205K) points out that “the 96% false positive rate among the 27% of positive scans found in the NLST drew plenty of attention.” However, “the LUNGRADS structured reporting and management system criteria should help fix that, argued Ella Kazerooni, MD, director of cardiothoracic radiology at the University of Michigan in Ann Arbor and a representative for the American College of Radiology.” Dr. Kazerooni “said the criteria would bring the false-positive rate down to one in 10, although the panel seemed unconvinced without seeing data to back it up.”
编后：结论是不适合，CT沦落成为了医院赚钱的工具，印钞机！还致癌！