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Screening des Lungenkarzinoms: Stand 2007

Lung cancer screening: status in 2007

  • Leitthema: Screening
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Zusammenfassung

Überlegungen zum Screening des Lungenkarzinoms werden motiviert durch die sehr schlechte Prognose des Tumors bei Diagnose aufgrund von Symptomen (<15% 5-Jahres-Überleben), die deutlich bessere Prognose asymptomatischer früher Stadien (bis 80% 5-Jahres-Überleben), die hohe Sensitivität der nativen Niedrigdosis-CT für kleine Tumoren und die gute Identifizierbarkeit von Risikopersonen.

Machbarkeitsstudien unter Verwendung genau definierter diagnostischer Algorithmen zum Umgang mit gefundenen Lungenrundherden zeigten einen großen Anteil (>50 bis >90%) kleiner, resektabler nichtkleinzelliger Lungenkarzinome in frühen Stadien mit guter Prognose der betroffenen Patienten bei einer geringen Rate unnötiger Biopsien. Da allerdings Verzerrungsfaktoren wie Überdiagnose, length-time und lead-time Aussagen zum tatsächlichen Nutzen der Methode hinsichtlich einer Senkung der Sterblichkeit am Lungenkarzinom nicht zulassen, werden derzeit die Ergebnisse großer prospektiver randomisierter Studien abgewartet.

Gleichzeitig sind andere Früherkennungsmethoden wie verfeinerte Sputumdiagnostik, Analyse molekularer Marker im Blut oder Atemluftanalyse in der Evaluation.

Abstract

Thoughts on screening for lung cancer are based on the very poor prognosis of this tumor when the diagnosis is made because of symptoms (<15% 5-year survival), the markedly better prognosis if it is detected in asymptomatic early stages (up to 80% 5-year survival), the high sensitivity of unenhanced low-dose CT in the detection of small tumors, and the clear definition of persons at risk.

Feasibility studies using well-defined diagnostic algorithms for management of detected pulmonary nodules have demonstrated a high proportion (>50 to >90%) of small, resectable non-small-cell lung carcinomas in the early stages, with a good prognosis for the patients affected and a low rate of unnecessary biopsies. However, biases such as overdiagnosis, length-time and lead-time could hamper potential reduction of mortality from lung cancer, and the results of large prospective randomized trials are therefore awaited.

At the same time, other techniques for early diagnosis of lung cancer are under evaluation, such as sophisticated methods of sputum analysis, molecular markers in the blood and analysis of exhaled air.

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  1. Institut für Diagnostische und Interventionelle Radiologie, Marien-Hospital, Rochusstr. 2, 40479, Düsseldorf, Deutschland

    S. Diederich

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Diederich, S. Screening des Lungenkarzinoms: Stand 2007. Radiologe 48, 39–44 (2008). https://doi.org/10.1007/s00117-007-1585-6

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