Screening for Lung Cancer: CHEST Guideline and Expert Panel Report

Chest: The Journal of Circulation, Respiration and Related Systems

Sheena Patel^3¹  Renda Soylemez Wiener^6,7²  Jeffrey P. Kanne^4³  Gerard A. Silvestri^2⁴  Peter J. Mazzone^1⁵  Guy Soo Hoo^8⁷  Frank C. Detterbeck^9⁸  Linda S. Kinsinger^5⁹ 

[1] CHEST, Glenview, IL^3;Center for Healthcare Organization & Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA^6;Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI^4;Division of Pulmonary and Critical Care, Department of Medicine, Medical University of South Carolina, Charleston, SC^2;Respiratory Institute, Cleveland Clinic, Cleveland, OH^1;Section of Thoracic Surgery, Department of Surgery, Yale University, New Haven, CT^9;The Pulmonary Center, Boston University School of Medicine, Boston, MA^7;VA Greater Los Angeles Healthcare System, Los Angeles, CA^8;VHA National Center for Health Promotion and Disease Prevention, Durham, NC^5

关键词: evidence-based medicine;    guidelines;    lung cancer;    ACR;    American College of Radiology;    CHEST;    American College of Chest Physicians;    CISNET;    Cancer Intervention and Surveillance Modeling Network;    CMS;    Centers for Medicare & Medicaid Services;    COI;    conflict of interest;    CXR;    chest radiograph;    GRADE;    Grading of Recommendations;    Assessment;    Development;    and Evaluation;    HR;    hazard ratio;    LDCT;    low-dose CT;    PICO;    population;    intervention;    comparator;    outcome;    SES;    socioeconomic status;    RR;    risk ratio;    SEER;    Surveillance;    Epidemiology;    and End Results;    STR;    Society of Thoracic Radiology;    USPSTF;    United States Preventative Services Task Force;   

DOI  :  10.1016/j.chest.2018.01.016

学科分类：呼吸医学

来源: American College of Chest Physicians

【 摘 要 】

Background Low-dose chest CT screening for lung cancer has become a standard of care in the United States in the past few years, in large part due to the results of the National Lung Screening Trial. The benefit and harms of low-dose chest CT screening differ in both frequency and magnitude. The translation of a favorable balance of benefit and harms into practice can be difficult. Here, we update the evidence base for the benefit, harms, and implementation of low radiation 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. Methods Approved panelists developed key questions using the PICO (population, intervention, comparator, and outcome) format to address the benefit and harms of low-dose CT screening, as well as key areas of program implementation. A systematic literature review was conducted by using MEDLINE via PubMed, Embase, and the Cochrane Library. Reference lists from relevant retrievals were searched, and additional papers were added. The quality of the evidence was assessed for each critical or important outcome of interest using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. 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. Results The systematic literature review identified 59 studies that informed the response to the 12 PICO questions that were developed. Key clinical questions were addressed resulting in six graded recommendations and nine ungraded consensus based statements. Conclusions Evidence suggests that low-dose CT screening for lung cancer results in a favorable but tenuous balance of benefit and harms. The selection of screen-eligible patients, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can affect this balance. Additional research is needed to optimize the approach to low-dose CT screening.

【 授权许可】

CC BY