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Lungenkarzinomscreening mit Röntgenthorax oder CT

Aktuelle Datenlage

Lung cancer screening with thoracic X‑ray and CT

Current situation

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Zusammenfassung

Klinisches/methodisches Problem

Bestrebungen zur Früherkennung von Lungenkrebs mit bildgebenden Methoden gibt es schon lange.

Radiologische Standardverfahren

Alle Studien, die eine Reduktion der Lungenkrebsmortalität mittels Röntgenthoraxscreening nachzuweisen versuchten, scheiterten.

Methodische Innovationen

Auch die ersten kleineren Screeningstudien mit der CT konnten keine Reduktion der Lungenkrebssterblichkeit nachweisen, bis 2011 die Ergebnisse der bisher größten randomisierten kontrollierten Niedrigdosis-CT-Screeningstudie (NLST) aus den USA veröffentlicht wurden. Diese konnten eine signifikante 20 %ige Reduktion der Lungenkrebssterblichkeit bei Personen, die älter und starke Raucher waren, mit der CT nachweisen.

Leistungsfähigkeit

Eine Bestätigung dieses Erfolgs erscheint dringend geboten, sodass die Daten der größten europäischen Studie (NELSON) sehnlichst erwartet werden.

Bewertung

Die Daten der zahlreichen europäischen Studien werden zusammengefasst, um wichtige Informationen und Evidenz für die Etablierung zukünftiger CT-Screeningprogramme liefern.

Empfehlung für die Praxis

Randomisierte kontrollierte Studien sind die Basis der evidenzbasierten Medizin. Daher dürfen die positiven Ergebnisse der auch methodisch sehr guten NLST-Studie nicht ignoriert werden, selbst wenn bisher nur eine solche aussagestarke Studie abgeschlossen ist. NLST macht jedoch auch klar, dass positive Effekte für die Gesundheit der Bevölkerung nur zu erwarten sind, wenn die Prozesse klar definiert und die Qualität gesichert sind.

Abstract

Clinical/methodical issue

Attempts at the early detection of lung cancer using imaging methods began as far back as the 1950s.

Standard radiological methods

Several studies attempted to demonstrate a reduction of lung cancer mortality by chest radiography screening but all were unsuccessful.

Methodical innovations

Even the first small screening studies using computed tomography (CT) could not demonstrate a reduction in lung cancer-specific mortality until in 2011 the results of the largest randomized controlled low-dose CT screening study in the USA (NLST) were published. The NLST results could show a significant 20 % reduction of lung cancer mortality in elderly and heavy smokers using CT.

Performance

Confirmation of the NLST results are urgently needed so that the data of the largest European study (NELSON) are eagerly awaited.

Achievements

Pooled with the data from several smaller European studies these results will provide important information and evidence for the establishment of future CT screening programs in Europe.

Practical recommendations

Randomized controlled trials are the basis of evidence-based medicine; therefore, the positive results of the methodologically very good NLST study cannot be ignored, even if it is the only such study completed so far with highly convincing conclusions. The NLST results clearly demonstrate that positive effects for the health of the population can only be expected if the processes are clearly defined and the quality is assured.

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Abbreviations

DANTE:

Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays

DLCST:

Danish Lung Cancer Screening Trial

ERS:

European Respiratory Society

ESR:

European Society of Radiology

IELCAP:

International Early Lung Cancer Action Program

ITALUNG:

Italian Lung Study

LDCT:

Low-Dose Computed Tomography/Niedrigdosis-CT

LUSI:

Lung Cancer Screening Intervention Trial

MILD:

Multicentric Italian Lung Detection

NELSON:

Nederlands-Leuvens Longkanker Screenings Onderzoek

NLST:

National Lung Screening Trial

QALY:

Quality-Adjusted Life Year/Qualitätskorrigiertes Lebensjahr

UKLS:

UK Lung Screen

VDT:

Volume Doubling Time/Volumendopplungszeit

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Authors and Affiliations

  1. Diagnostische und Interventionelle Radiologe, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland

    O. von Stackelberg & H.-U. Kauczor

  2. Translationales Lungen Forschungszentrum Heidelberg (TLRC), Mitglied des Deutschen Zentrums für Lungenforschung (DZL), Im Neuenheimer Feld 430, 69120, Heidelberg, Deutschland

    O. von Stackelberg & H.-U. Kauczor

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  1. O. von Stackelberg
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Correspondence to H.-U. Kauczor.

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O. von Stackelberg und H.-U. Kauczor geben an, dass kein Interessenkonflikt besteht.

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

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von Stackelberg, O., Kauczor, HU. Lungenkarzinomscreening mit Röntgenthorax oder CT. Radiologe 56, 793–797 (2016). https://doi.org/10.1007/s00117-016-0141-7

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