CT-Screening beim Lungenkarzinom – wie ist die Evidenz?

Was ist neu?

Effektivität des CT-Screenings Die amerikanische NLST-Studie hat erste wichtige Erkenntnisse über die Senkung der Lungenkrebsletalität mittels CT-Screening geliefert. Kritikpunkte dieser Studie sind die hohen Raten an falsch positiven Befunden und Überdiagnosen sowie die relativ kurze Nachbeobachtungszeit. Vorläufige Ergebnisse europäischer Studien konnten die Senkung der Letalität der NLST-Studie nicht bestätigen. Das CT-Screening ist in Deutschland nicht als Früherkennungsuntersuchung zugelassen.

Aktueller Status der Biomarker-Entwicklung zur Früherkennung des Lungenkarzinoms Innovative Verfahren zur Ergänzung des CT-Screenings sind momentan Gegenstand der Forschung. Hierzu zählen Blutuntersuchungen, die sogenannten Liquid Biopsies, sowie die Analyse von Atemgas-Kondensaten. Die Analyse von Blutproben erlaubt die Detektion molekularer Veränderungen. Mithilfe von Atemtests sind sogar minimale Veränderungen in der Zusammensetzung des Atemgases messbar, sodass mithilfe dieser Methode Lungenkarzinome bereits im Frühstadium erkannt werden können. Beide Verfahren könnten in Zukunft unter Umständen einen Tumor zeitlich vor der Bildgebung erkennen und würden somit die herkömmlichen bildgebenden Verfahren ergänzen. Ein weiteres Einsatzgebiet beider Methoden wäre die Identifizierung falsch positiver Lungenkrebsbefunde.

Abstract

In patients with lung cancer treatment opportunities and prognosis are correlated to the stage of disease with a chance for curative treatment in patients with early stage disease. Therefore, early detection of lung cancer is of paramount importance for improving the prognosis of lung cancer patients.

The National Lung Screening Trial (NLST) has already shown that low-dose CT increases the number of identified early stage lung cancer patients and reduces lung cancer related mortality. Critically considered in terms of CT-screening are false-positive results, overdiagnosis and unessential invasive clarification. Preliminary results of relatively small European trials haven´t yet confirmed the results of the NLST-study.

Until now Lung Cancer Screening by low dose CT-scan or other methods is neither approved nor available in Germany.

To improve the efficacy of CT-Screening and to introduce early detection of lung cancer in standard practice, additional, complementing methods should be further evaluated. One option might be the supplementary analysis of biomarkers in liquid biopsies or exhaled breath condensates. In addition, defining the high-risk population is of great relevance to identify candidates who might benefit of early detection programs.

Schlüsselwörter

Lungenkarzinom - Früherkennung - Screening - CT

Key words

lung cancer - early detection - screening - CT

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