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Lungenkrebsfrüherkennung

Early recognition of lung cancer

  • Leitthema
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Der Pneumologe Aims and scope

Zusammenfassung

Lungenkrebs ist weltweit eine der Krebsarten mit der höchsten Mortalitätsrate. Die häufigste Art von Lungenkrebs ist das nicht-kleinzellige Bronchialkarzinom (NSCLC). Therapieoptionen und Prognose der Erkrankung hängen wesentlich vom initialen Tumorstadium ab. Patienten, bei denen die Diagnose in einem frühen Stadium gestellt wurde, können kurativ operiert werden. Leider erfolgt die Diagnosestellung häufig erst in einem fortgeschrittenen Tumorstadium. Es wurden bereits mehrere Studien zur Lungenkrebsfrüherkennung mittels Computertomographie (CT) durchgeführt. 2011 wurden die Ergebnisse des amerikanischen National Lung Screening Trial (NLST) bei starken Rauchern oder Exrauchern veröffentlicht, das eine signifikante Reduktion der Lungenkrebsmortalität aufzeigte. Basierend darauf werden auch in Deutschland CT-Untersuchungen zur Lungenkrebsfrüherkennung angeboten und nachgefragt. Die aktuelle Röntgenverordnung (RöV, §23) lässt dieses Vorgehen allerdings nicht zu („graues Screening“), wenn keine rechtfertigende Indikation vorliegt; solche Maßnahmen sind daher derzeit nicht zulässig. Darüber hinaus gehen Früherkennungsmaßnahmen und deren Abklärung mit Belastungen einher und zeigen bei mehr als jedem Vierten falsch-positive Befunde. Um dem nachvollziehbaren Wunsch nach früher Lungenkrebsdiagnose mittels Screening nachkommen zu können, gilt es daher, eine qualitätsgesicherte Untersuchungskette zur individuellen Früherkennung von Lungenkrebs mittels Niedrigdosis-CT zu definieren, ähnlich wie bereits in den USA erfolgt. Ziel dieses Reviews ist es, aktuelle Daten aufzuzeigen und dabei die zu beachtenden Probleme zu diskutieren.

Abstract

Lung cancer is one of the forms of cancer with the highest mortality worldwide. The most common type of lung cancer is non-small cell lung carcinoma (NSCLC). Treatment options and prognosis of the disease essentially depend on the initial tumor stage. Patients in whom the diagnosis is made early can be operatively treated with curative intent. Unfortunately, diagnosis is often made at an advanced tumor stage. Several studies have been carried out on early detection of lung cancer by computed tomography (CT). The results of the American National Lung Screening Trial (NLST), which showed a significant reduction in lung cancer mortality among heavy smokers and ex-smokers were published in 2011. Under the current regulations for x‑ray examinations (RöV §23) this procedure is not allowed (grey area screening) when there are no justified indications and such measures are therefore currently prohibited. It can be assumed that in the future CT examination for early detection of lung cancer will be provided and required in Germany; however, early identification measures and their clarification are associated with stress and often show false positive findings. In order to meet the understandable desire for early diagnosis of lung cancer, it is therefore necessary to define a quality assured examination chain for individual early detection of lung cancer by means of low-dose CT, similar to the USA. The goal of this review is to present current data and also to discuss the problems to be considered.

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Authors and Affiliations

  1. Abteilung für Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Röntgenstr. 1, 69126, Heidelberg, Deutschland

    F. J. F. Herth

  2. Abteilung für diagnostische und interventionelle Radiologie, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    C. P. Heussel

  3. Translational Lung Research Center Heidelberg (TLRCH), German Lung Research Foundation (DZL), Heidelberg, Deutschland

    F. J. F. Herth & C. P. Heussel

Authors
  1. F. J. F. Herth
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  2. C. P. Heussel
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Correspondence to F. J. F. Herth.

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Interessenkonflikt

F.J.F. Herth und C.P. Heussel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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H. Olschewski, Graz

F.J.F Herth, Heidelberg

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Herth, F.J.F., Heussel, C.P. Lungenkrebsfrüherkennung. Pneumologe 14, 140–148 (2017). https://doi.org/10.1007/s10405-017-0103-4

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