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Zentralbl Chir 2013; 138(S 01): S11-S15
DOI: 10.1055/s-0033-1350855
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Lungenkrebsscreening aktuell – Wo stehen wir 2013?

Lung Cancer Screening – Where Are We in 2013?
H. Prosch
1   Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Österreich
,
G. Mostbeck
2   Institut für diagnostische und interventionelle Radiologie, Wilhelminenspital, Wien, Österreich
3   Institut für Röntgendiagnostik, Otto Wagner Spital, Wien, Österreich
› Author Affiliations
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Publication History

Publication Date:
22 October 2013 (online)

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Zusammenfassung

Das Lungenkarzinom ist eine der führenden Todesursachen in Europa und den USA. Eine relativ gute Prognose bleibt jenen Patienten vorbehalten, bei denen das Lungenkarzinom in einem frühen Stadium entdeckt wird. Da das Lungenkarzinom sich jedoch erst sehr spät in seinem Verlauf durch klinische Symptome bemerkbar macht, sind die meisten Patienten zum Zeitpunkt der Diagnose in einem weit fortgeschrittenen Tumorstadium und können daher nur noch palliativ behandelt werden. Aus diesem Grund könnte eine Frühdiagnose durch Screening Leben retten. Das National Lung Screening Trial (NLST) konnte in einer prospektiven randomisierten Studie zeigen, dass durch ein Screening mit einer Niedrigdosis-CT (low dose, LD-CT) die Lungenkarzinommortalität um 20,0 % gesenkt werden kann. Die überaus positiven Daten des NLST konnten bisher nicht durch die ersten Daten der noch laufenden europäischen Studien bestätigt werden. Wenn auch die europäischen Studien eine Mortalitätsverbesserung durch ein LD-CT-Screening zeigen sollten, so müssen vor der Implementierung von Screeningprogrammen eine Reihe von Fragen beantwortet werden. Allen voran die genaue Definition jener Personengruppe, die am meisten von einem Screening profitieren würde und die Frage nach der Abklärung der vielen im Screening gefundenen Rundherde, von denen der größte Teil benigne ist. In diesem Review-Artikel werden die Resultate der NLST und der ersten Daten der europäischen Studien zusammengefasst und die noch offenen Fragen diskutiert.

Abstract

Lung cancer is one of the leading causes of death in Europe and the USA. A relatively good prognosis is limited to those patients in whom the tumor is detected at an early stage. As clinical symptoms of lung cancer are a late finding in the natural course of the disease, most of the patients are diagnosed at an advanced tumor stage when palliative care remains the only therapeutic option. For this reason, early diagnosis of lung cancer might save lives. The National Lung Screening Trial (NLST), in the U. S. A., provided evidence that screening with low-dose CT (LD-CT) is able to reduce lung cancer mortality by 20.0 %. The encouraging results of the NLST, however, could not be confirmed by the preliminary results of ongoing European trials. Even if the European trials are able to confirm a reduction in lung cancer mortality by LD-CT, a number of important questions must be answered before the implementation of nationwide screening programs. First of all, the population that might benefit from CT lung cancer screening has to be defined precisely. Furthermore, guidelines have to be established about how to manage screening participants with detected lung nodules, as the vast majority of these pulmonary nodules will prove to be benign. This review article summarizes the results of the NLST and the initial data from the European screening trials, and will discuss some of the major open questions in lung cancer screening with CT.

Schlüsselwörter

Screening - Lungenkarzinom - bildgebende Verfahren

Key words

screening - lung cancer - imaging
 

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