在CT扫描筛查肺癌时发现慢性阻塞性肺病

Identification of Chronic Obstructive Pulmonary Disease in Lung Cancer Screening Computed Tomographic Scans
作者:Mets Buckens Zanen 【View at publisher】 【全球专家评论】
期刊: JAMA2012年1月期卷 专家评级:★★ 循证评级:B

Context:

Smoking is a major risk factor for both cancer and chronic obstructive pulmonary disease (COPD). Computed tomography (CT)–based lung cancer screening may provide an opportunity to detect additional individuals with COPD at an early stage.

Objective:

To determine whether low-dose lung cancer screening CT scans can be used to identify participants with COPD.

Design, Setting, and Patients:

Single-center prospective cross-sectional study within an ongoing lung cancer screening trial. Prebronchodilator pulmonary function testing with inspiratory and expiratory CT on the same day was obtained from 1140 male participants between July 2007 and September 2008. Computed tomographic emphysema was defined as percentage of voxels less than −950 Hounsfield units (HU), and CT air trapping was defined as the expiratory:inspiratory ratio of mean lung density. Chronic obstructive pulmonary disease was defined as the ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) of less than 70%. Logistic regression was used to develop a diagnostic prediction model for airflow limitation.

Main Outcome Measures:

Diagnostic accuracy of COPD diagnosis using pulmonary function tests as the reference standard.

Results:

Four hundred thirty-seven participants (38%) had COPD according to lung function testing. A diagnostic model with CT emphysema, CT air trapping, body mass index, pack-years, and smoking status corrected for overoptimism (internal validation) yielded an area under the receiver operating characteristic curve of 0.83 (95% CI, 0.81-0.86). Using the point of optimal accuracy, the model identified 274 participants with COPD with 85 false-positives, a sensitivity of 63% (95% CI, 58%-67%), specificity of 88% (95% CI, 85%-90%), positive predictive value of 76% (95% CI, 72%-81%); and negative predictive value of 79% (95% CI, 76%-82%). The diagnostic model showed an area under the receiver operating characteristic curve of 0.87 (95% CI, 0.86-0.88) for participants with symptoms and 0.78 (95% CI, 0.76-0.80) for those without symptoms.

Conclusion:

Among men who are current and former heavy smokers, low-dose inspiratory and expiratory CT scans obtained for lung cancer screening can identify participants with COPD, with a sensitivity of 63% and a specificity of 88%.

学科代码:呼吸病学 肿瘤学 放射学   关键词:在CT扫描筛查肺癌时发现慢性阻塞性肺病
来源: 国际医学期刊
国际医学期刊介绍:信息来自于Pubmed,包括超过2100万出处生物医学文献来自Medline、生命科学期刊、在线书籍。引用内容链接到全文内容、公共医学中心和出版商的网站。 马上访问国际医学期刊网站http://www.pubmed.com/
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