期刊
CHEST
卷 142, 期 2, 页码 377-384出版社
ELSEVIER
DOI: 10.1378/chest.11-2030
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资金
- Zorg Onderzoek Nederland-Medische Wetenschappen
- KWE Kankerbestrijding
- Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen
- G. Ph. Verhagen Foundation
- Rotterdam Oncologic Thoracic Study Group
- Erasmus Trust Fund
- Stichting tegen Kanker (Belgium)
- Vlaamse Liga tegen Kanker
- LOGO Leuven and Hageland
- Roche Diagnostics
Background: Up to 50% of the participants in CT scan lung cancer screening trials have at least one pulmonary nodule. To date, the role of conventional bronchoscopy in the workup of suspicious screen-detected pulmonary nodules is unknown. If a bronchoscopic evaluation could be eliminated, the cost-effectiveness of a screening program could be enhanced and the potential harms of bronchoscopy avoided. Methods: All consecutive participants with a positive result on a CT scan lung cancer screening between April 2004 and December 2008 were enrolled. The diagnostic sensitivity and negative predictive value were calculated at the level of the suspicious nodules. In 95% of the nodules, the gold standard for the outcome of the bronchoscopy was based on surgical resection specimens. Results: A total of 318 suspicious lesions were evaluated by bronchoscopy in 308 participants. The mean +/- SD diameter of the nodules was 14.6 +/- 8.7 mm, whereas only 2.8% of nodules were > 30 mm in diameter. The sensitivity of bronchoscopy was 13.5% (95% CI, 9.0%-19.6%); the specificity, 100%; the positive predictive value, 100%; and the negative predictive value, 47.6% (95% CI, 41.8%-53.5%). Of all cancers detected, 1% were detected by bronchoscopy only and were retrospectively invisible on both low-dose CT scan and CT scan with IV contrast. Conclusion: Conventional white-light bronchoscopy should not be routinely recommended for patients with positive test results in a lung cancer screening program. Trial registration: Nederlands Trial Register; No.: ISRCTN63545820; URL: www.trialregister.nl. CHEST 2012; 142(2):377-384
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