Radiologisches Screening des Bronchialkarzinoms: Aktueller Stand und zukünftige Perspektiven[1]

Zusammenfassung.

Das Bronchialkarzinom ist der am häufigsten zum Tode führende maligne Tumor, v. a. als Folge seiner ausgesprochen schlechten Prognose bei zum Diagnosezeitpunkt in der Regel fortgeschrittenem Tumorstadium. In frühen, meist asymptomatischen Tumorstadien ist die Prognose insbesondere bei nicht-kleinzelligen Typen sehr viel günstiger, so dass die Früherkennung mittels diagnostischer Verfahren eine Senkung der Sterblichkeit am Bronchialkarzinom erwarten lässt. Die Computertomographie erscheint aufgrund ihrer hohen Sensitivität für kleine Lungenrundherde, eine Hauptmanifestation früher Bronchialkarzinome, besonders als Früherkennungsuntersuchung geeignet, insbesondere da ihre in Standarduntersuchungsprotokollen relativ hohe Strahlenexposition sich für diesen Zweck erheblich reduzieren lässt. Wegen der Häufigkeit kleiner benigner Lungenrundherde sind allerdings diagnostische Algorithmen zur nicht-invasiven Dignitätszuordnung gefundener Läsionen unerlässlich. Erste Studien zur Niedrigdosis-CT unter Verwendung von auf Größe und Dichte gefundener Rundherde basierenden Algorithmen ergaben einen großen Anteil asymptomatischer Bronchialkarzinome; der Anteil früher, resektabler Tumorstadien war ausgesprochen hoch und die Zahl invasiver Maßnahmen wegen benigner Läsionen gering. Vor dem breiten Einsatz solcher Verfahren in der klinischen Praxis sind jedoch weitere Daten zu sinnvollen Einschlusskriterien, Screeningintervallen und letztlich der Nachweis einer Reduktion der Mortalität am Bronchialkarzinom durch Screening zu fordern.

Radiologic screening for lung cancer: present status and future perspectives.

Lung cancer is the most common cause of death from malignancy. This is predominantly due to the poor prognosis of the mostly advanced tumor stages at the time of presentation. Prognosis of early, usually asymptomatic stages is more favourable, particularly in non-small-cell histologic types. Therefore, early detection using diagnostic tests promises reduction of mortality from lung cancer. Due to its high sensitivity for small pulmonary nodules - the most common manifestation of early lung cancer - computed tomography appears suitable as a screening test particularly as the high radiation exposure associated with standard examination protocols can be significantly reduced for this purpose. Due to the high prevalence of benign small pulmonary nodules diagnostic algorithms are required for non-invasive classification of detected nodules. Preliminary studies of low-dose CT using algorithms based on size and density of detected nodules revealed a high proportion of asymptomatic lung cancers and early resectable tumor stages with a small number of invasive procedures for benign nodules. Prior to a wide application of this technique in clinical routine more data is required as to appropriate inclusion criteria, screening intervals and most importantly the effect of screening on reduction of mortality from lung cancer.

Lungenrundherd - Bronchialkarzinom - Früherkennung - Mortalität - Niedrigdosis-CT

Lung nodule - Lung neoplasm, Diagnosis - Cancer screening - Computed tomography

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1 Diese Arbeit ist Herrn Prof. Dr. med. Peter E. Peters, dem früheren Direktor des Instituts für Klinische Radiologie der Westfälischen Wilhelms-Universität Münster, gewidmet, dem die Förderung der Forschung auf dem Gebiet der Krebsfrüherkennung ein persönliches Anliegen war.