Lungenkrebs-Screening und Management kleinerer pulmonaler Rundherde

Zusammenfassung

Lungenkrebs wird mehrheitlich im fortgeschrittenen Stadium diagnostiziert. Daher ist die Prognose ungünstig. Indem die Erkrankung in einem früheren Stadium diagnostiziert wird, kann das Überleben der Patienten verbessert werden. Die Einführung eines bevölkerungsweiten Lungenkrebs-Screening-Programms mittels Low-dose-Computertomografie könnte dazu beitragen, die Prognose und das Überleben der Patienten zu verbessern.

Der rasche technische Fortschritt in der Bildgebung erlaubt es mittlerweile, auch wenige Millimeter messende Läsionen zu detektieren. Dies macht neue diagnostische und therapeutische Algorithmen für das Management auffälliger oder ätiologisch unklarer pulmonaler Rundherde notwendig, die im Rahmen von Screening-Untersuchungen oder auch zufällig gefunden werden.

Der nachfolgende Artikel beleuchtet neue Daten zum Lungenkrebs-Screening sowie Empfehlungen zum Management kleinerer pulmonaler Rundherde.

Abstract

Worldwide lung cancer is the leading cause of death from cancer. Most lung cancers are diagnosed at an advanced stage, so survival after lung cancer is generally poor. Diagnosis of lung cancer at earlier stages may be associated with an increased survival rate. This indicates that the implementation of lung cancer screening programs at the population level by means of low dose computed tomography might helpful to improve the outcome and mortality of lung cancer patients.

By means of rapid advances in imaging technologies over the last decades it became possible to detect small lung nodules as small as a couple of millimeters. This recent developments require management algorithms to guide the clinical management of suspicious and indeterminate lung nodules found in computer tomography during lung cancer screening or by incidental finding.

This review will focus on both, the recent advances in lung cancer screening and the guidelines for the management of small pulmonary nodules.

Schlüsselwörter

Lungenkrebs - Mortalität - Screening - pulmonale Rundherde

Key Words

lung cancer - mortality - screening - pulmonary nodules

• Literaturverzeichnis

• 1 Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest 2009; 136: 260-271
• 2 Aberle DR, Adams AM, Berg CD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395-409
• 3 Ost DE, Gould MK. Decision making in patients with pulmonary nodules. Am J Respir Crit Care Med 2012; 185: 363-372
• 4 Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med 2003; 348: 2535-2542
• 5 Patz EF, Goodman PC, Bepler G. Screening for lung cancer. N Engl J Med 2000; 343: 1627-1633
• 6 Manser RL, Irving LB, Byrnes G et al. Screening for lung cancer: a systematic review and meta-analysis of controlled trials. Thorax 2003; 58: 784-789
• 7 Oken MM, Hocking WG, Kvale PA et al. Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial. JAMA 2011; 306: 1865-1873
• 8 Henschke CI. Early lung cancer action project: overall design and findings from baseline screening. Cancer 2000; 89: 2474-2482
• 9 Aberle DR, DeMello S, Berg CD et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med 2013; 369: 920-931
• 10 Jacobson FL, Austin JHM, Field JK et al. Development of The American Association for Thoracic Surgery guidelines for low-dose computed tomography scans to screen for lung cancer in North America: recommendations of The American Association for Thoracic Surgery Task Force for Lung Cancer Screening and Surveillance. J Thorac Cardiovasc Surg 2012; 144: 25-32
• 11 Jaklitsch MT, Jacobson FL, Austin JHM et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 2012; 144: 33-38
• 12 Bach PB, Mirkin JN, Oliver TK et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012; 307: 2418-2429
• 13 Couraud S, Cortot AB, Greillier L et al. From randomized trials to the clinic: is it time to implement individual lung-cancer screening in clinical practice? A multidisciplinary statement from French experts on behalf of the French intergroup (IFCT) and the groupe d’Oncologie de langue francaise (GOLF). Ann Oncol 2013; 24: 586-597
• 14 Vogelmeier C, Worth H, Pfeifer M et al. Gemeinsame Stellungnahme der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Röntgengesellschaft zur Lungenkrebsfrüh­erkennung mit Niedrigdosis-CT. Pneumologie 2011; 65: 5-6
• 15 MacMahon H, Austin JHM, Gamsu G et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005; 237: 395-400
• 16 Naidich DP, Bankier AA, MacMahon H et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2013; 266: 304-317
• 17 Gould MK, Fletcher J, Iannettoni MD et al. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132: 108S-130S
• 18 Patel VK, Naik SK, Naidich DP et al. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 2: pretest probability and algorithm. Chest 2013; 143: 840-846
• 19 Wahidi MM, Govert JA, Goudar RK et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132: 94S-107S
• 20 Siegelman SS, Khouri NF, Scott WW et al. Pulmonary hamartoma: CT findings. Radiology 1986; 160: 313-317
• 21 Erasmus JJ, McAdams HP, Connolly JE. Solitary pulmonary nodules: Part II. Evaluation of the indeterminate nodule. Radiographics 2000; 20: 59-66
• 22 Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin 2010; 60: 277-300
• 23 Godoy MCB, Naidich DP. Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology 2009; 253: 606-622
• 24 Travis WD, Brambilla E, Noguchi M et al. International association for the study of lung cancer / american thoracic society / european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6: 244-285
• 25 Suzuki K, Asamura H, Kusumoto M et al. „Early“ peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan. Ann Thorac Surg 2002; 74: 1635-1639
• 26 Watanabe S, Watanabe T, Arai K et al. Results of wedge resection for focal bronchioloalveolar carcinoma showing pure ground-glass attenuation on computed tomography. Ann Thorac Surg 2002; 73: 1071-1075
• 27 Hasegawa M, Sone S, Takashima S et al. Growth rate of small lung cancers detected on mass CT screening. Br J Radiol 2000; 73: 1252-1259
• 28 Murrmann GB, van Vollenhoven FHM, Moodley L. Approach to a solid solitary pulmonary nodule in two different settings-„Common is common, rare is rare“. J Thorac Dis 2014; 6: 237-248
• 29 Lindell RM, Hartman TE, Swensen SJ et al. 5-year lung cancer screening experience: growth curves of 18 lung cancers compared to histologic type, CT attenuation, stage, survival, and size. Chest 2009; 136: 1586-1595
• 30 Baldwin DR, Duffy SW, Wald NJ et al. UK Lung Screen (UKLS) nodule management protocol: modelling of a single screen randomised controlled trial of low-dose CT screening for lung cancer. Thorax 2011; 66: 308-313
• 31 Becker N, Motsch E, Gross M et al. Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round. J Cancer Res Clin Oncol 2012; 138: 1475-1486
• 32 Blanchon T, Bréchot J, Grenier PA et al. A Baseline results of the Depiscan study: a French randomized pilot trial of lung cancer screening comparing low dose CT scan (LDCT) and chest X-ray (CXR). Lung Cancer 2007; 58: 50-58
• 33 Infante M, Cavuto S, Lutman FR et al. A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am J Respir Crit Care Med 2009; 180: 445-453
• 34 Lopes Pegna A, Picozzi G, Falaschi F et al. Four-year results of low-dose CT screening and nodule management in the ITALUNG trial. J Thorac Oncol 2013; 8: 866-875
• 35 Pastorino U, Rossi M, Rosato V et al. Annual or biennial CT screening versus observation in heavy smokers: 5-year results of the MILD trial. Eur J Cancer Prev 2012; 21: 308-315
• 36 Saghir Z, Dirksen A, Ashraf H et al. CT screening for lung cancer brings forward early disease. The randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT. Thorax 2012; 67: 296-301
• 37 van Klaveren RJ, Oudkerk M, Prokop M et al. Management of lung nodules detected by volume CT scanning. N Engl J Med 2009; 361: 2221-2229