Lungenkrebsfrüherkennung: eine Bestandsaufnahme

Zusammenfassung

Die Evidenz für den Nutzen und die Risiken eines Lungenkarzinomscreenings stützt sich im Wesentlichen auf eine einzelne große randomisiert-kontrollierte Studie, in der eine signifikante Reduktion der Lungenkrebssterblichkeit bei Risikopersonen für ein Lungenkarzinom in der Gruppe mit CT-Screening im Vergleich zur Kontrollgruppe gezeigt wurde. Dem nachgewiesenen Nutzen stehen signifikante Risiken gegenüber. Die große – und bisher ungelöste – Problematik beim CT-Screening für Lungenkrebs ist die hohe Rate an falsch positiven Befunden. Die Abklärung dieser Befunde erfordert oft auch invasive diagnostische Prozeduren. Dabei auftretende Komplikationen stellen das Hauptrisiko dar, das mit einem CT-Screening für das Lungenkarzinom verbunden ist. Die deutschen und europäischen Fachgesellschaften halten sich derzeit mit einer Empfehlung für ein flächendeckendes CT-Screening für das Lungenkarzinom noch zurück. Das Nutzen-Risiko-Verhältnis wird als ungünstig beurteilt. Die für Ende 2018 angekündigten Ergebnisse der derzeit laufenden europäischen Studien (insbesondere „NELSON“ in den Niederlanden und „LUSI“ in Deutschland) sollen zunächst abgewartet werden. Es werden insbesondere Daten zu effektiveren Abklärungsalgorithmen mit niedrigeren Raten an falsch positiven Befunden und damit geringeren Komplikationsraten erwartet. Mit diesen Daten wird es eine neue Nutzen-Risiko-Abwägung geben.

Abstract

The evidence for the benefit and risks of lung cancer screening is based on a single large randomised controlled trial that showed a significant reduction in lung cancer mortality among lung cancer patients in the CT screening group compared to the control group. However, there are significant risks to the proven benefit. The large and unresolved problem in CT screening for lung cancer is the high rate of false positive findings. Further diagnostic work-up of these findings often requires invasive procedures. The complications that may occur are the main risk associated with CT screening for lung cancer. The German and European specialist associations are currently still holding back a recommendation for comprehensive CT screening for lung cancer. The risk benefit ratio is assessed as unfavourable. The results are awaited of the ongoing European studies (“NELSON” in the Netherlands and “LUSI” in Germany), which probably will be available by the end of 2018. Data are expected on more effective work-up algorithms with lower rates of false positive findings and thus lower complication rates. With these data, there will be a new risk benefit assessment.

Schlüsselwörter

Lungenkarzinom - Früherkennung - Niedrigdosis-Computertomografie - Nutzen - Risiken

Key words

lung cancer - early detection - screening - low-dose computed tomography - risk - benefit

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