| Objective:To explore the efficacy of baseline LDCT screening for lung cancer and pulmonary nodules and to analyze other lesions detected simultaneously as well.Materials and methods:A total of 9460 participants were enrolled in the LDCT lung cancer screening program-“Love the lungs” from August 2017 to December 2019,the baseline CT imaging of those were analyzed retrospectively.According to the Chinese expert consensus on screening and management of lung cancer(2019),participants were divided into high risk group and non-high risk group;according to age,participants were divided into youth group(<50 years old)and middle-and-elderly aged group(?50 years old),they were further divided as <50,50-59,60-69 and ?70;in the meanwhile,the participants were divided as smokers and non-smokers,non-smokers were also divided into secondhand smoke exposure and without secondhand smoke exposure,secondhand smoke exposure participants were divided into male individuals and female individuals.The results of pulmonary nodules were divided as three kinds as below.The standard of positive result for pulmonary nodules for baseline CT scan was to detect at least one of solid nodule or part-solid nodule larger than 5mm in diameter or non-solid nodule larger than 8mm;semi-positive result for at least one of solid nodule or part-solid nodule smaller than 5mm in diameter or non-solid nodule smaller than 8mm;negative result for only calcified nodules or none pulmonary nodule was detected.All LDCT images were uploaded to PACS system,and the nodules in lung and bronchial were observed,described and analyzed.Both the position,average diameter,shape and density of the nodules,and the pathological type,stage and the method of diagnosis of lung cancers were recorded.With the application of SPSS22.0 to analyze the results of each group of the LDCT lung cancer screening,the rate of positive result for pulmonary nodules,the number,detected rate and constituent ratio of lung cancers,and constituent ratio of lung cancers of stage-I were calculated in statistical method.Results:At baseline screening,9460 participants were recruited(4409 men and 5051 women).Median age was 60 years old(range from 40 to 74);1558(16.47%)cases at 40-49 years old,2922(30.89%)cases at50-59 years old,3993(42.21%)cases at 60-69 years old,987cases(10.43%)at 70-74 years old.Of these participants,2306(24.38%)were in high risk group and 7154(75.62%)in non-high risk group.There were 2601(27.49%)smokers(2449 men,accounting for 94.16%),729 smokers quitted smoking(693 men,accounting for 95.06%)and 6859(72.51%)non smokers(4899 women,accounting for 71.42%),including 1972 secondhand smoke exposure(1704 women,accounting for 86.41%).The difference in secondhand smoke exposure between different gender was statistically significant(P<0.001).Of these participants,295 cases(3.12%)had environmental or occupational exposure as asbestos,2122 cases(22.43%)had direct family history of malignant tumor(674 cases,7.12% for lung cancer)and 844 cases(8.92%)had pulmonary disease.Among 9460 participants,4708 cases(49.77%)were found pulmonary nodules.1468 cases(15.52%)were detected as positive result for pulmonary nodules,3240 cases(34.25%)as semi-positive result and 4752 cases(50.23%)as negative result.Among those with positive result,the positive result rate in high risk group was distinctly higher than the one in non-high risk group(18.82%vs14.45%)and the difference was statistically significant(P<0.05).The positive result rate of smokers was higher than non smokers(17.42% vs14.80%)and the difference was statistically significant(P<0.05).There was no significant difference between the positive result rate of the secondhand smoke exposure group and no secondhand smoke exposure group(14.00% vs15.08%,P=0.252).There was neither no significant difference between the positive result rate of different gender of the secondhand smoke exposure(male 14.93%vs female 13.85%,P=0.637).The positive result rate in ?50 years old group was distinctly higher than the one in <50 years old group(16.36% vs11.23%)and the difference was statistically significant(P<0.05).There was no significant difference between the positive result rate of the 40-44 years old group and 45-49 years old group(10.75%vs11.60%,P=0.598).The positive result rate of <50,50-59,60-69 and ?70 was respectively 11.23%,14.37%,16.98% and 19.76%.9116 pulmonary nodules were identified at baseline LDCT screening,there were 6505(71.36%)solid nodules,196(2.15%)part solid nodules,1496(16.41%)non-solid nodules and 919(10.08%)calcified nodules.61.34%(5592/9116)nodules with diameter less than 5mm,and most of them(86.78%,4853/5592)were solid nodules and calcified nodules.98 cases were confirmed as lung cancer by pathology(90 cases by surgeries,8 cases by transbronchial lung biopsy via fiberoptic bronchoscope or CT).The detection rate of lung cancer was1.04%(98/9460),the ratio of lung cancer amongst positive results was 6.67%(98/1468).There was no significant difference between male and female(41cases,0.93% vs 57 cases,1.13%,P =0.341).Median age was 62 years old(range from 42 to 74).Detection of lung cancer in high risk group did not show statistically significance between non-high risk group(1.30%vs0.95%,P= 0.148).There was no significant difference in the detection rate of lung cancer between the smokers and non-smokers(1.11%vs1.01%,P=0.640),between secondhand smoke exposure group and no secondhand smoke exposure group(1.12%vs0.96%,P =0.563),between different gender of the secondhand smoke exposure(male 0.75%vs female 1.17%,P==0.536).The detection rate of lung cancer in ?50 years old group was higher than <50 years old group(1.17%vs0.32%)and there was significant difference between them(P<0.05).There was no significant difference in the detection rate of lung cancer between the 40-44 and 45-49 years old group(0.45%vs0.23%,P=0.442).The incidence rate of lung cancer of <50,50-59,60-69 and ?70 years old was respectively 0.32%,0.86%,1.50% and 0.81%.Among 98 casesof lung cancer,82 cases were found at stage-I,with the constituent ratio of 83.77%(82/98).Also,5 cases were found at stage-II,6 cases at stage-III and 5 cases at stage-IV.Among 98 cases lung cancer,there were 76 cases of invasive adenocarcinoma,16 cases of micro-invasive adenocarcinoma,3 cases of preinvasive adenocarcinoma,one case of squamous carcinoma,one case of small cell lung cancer,one case of large cell neuroendocrine carcinoma.The proportion of adenocarcinoma was 96.94%.93 cases had single lesion and 5 cases had multiple lesions.96 cases manifested as peripheral lung cancer and 2 cases as central lung cancer.43 cases were lobulated shaped,30 cases showed with spicules of margin,2 cases accompanied with vacuole sign,10 cases had hilar and mediastinal lymphadenopathy.Totally there were 108 lung cancer lesions,solid nodule accounted for 31.48%(34/108),the mean diameter was 18.93±1.88mm(range 6.5-54.5mm);part-solid nodule accounted for 29.63%(32/108),the mean diameter was 15.89±8.44mm(range 6.0-35.9mm);non-solid nodule accounted for 38.89%(42/108),the mean diameter was 11.92±6.37mm(range 4.5.0-24.0mm).47(43.52%)lung cancer lesions located in the left lung(23 cases in upper left lung,24 cases in lower left lung),61 lesions located in the right lung(40 cases in upper right lung,5 cases in middle right lung,16 cases in lower right lung).There was no significant difference in the detection rate of lung cancer between those who had and did not have environmental or occupational exposure(0.68% vs 1.04%,P=0.537)There was significant difference in the detection rate of lung cancer between those who had and did not have direct family history of malignant tumor(2.50% vs 0.61%,P<0.05)The detection rate of pulmonary bulla,emphysema and COPD in high risk group were all distinctly higher than the one in non-high risk group(respectively 29.40% vs11.08%,16.78% vs2.95% and 4.86% vs0.66%)and the differences were statistically significant(P<0.05).The detection rate of pulmonary bulla,emphysema and COPD in smokers group were all distinctly higher than the one in non-smokers group(respectively 31.37% vs9.55%,16.99% vs2.37% and 5.07% vs0.39%)and the differences were statistically significant(P<0.05).The detection rate of coronary arterial calcification in high risk group was higher than the one in non-high risk group(8.02% vs5.75%),the one in non-smokers group was higher than the one in smokers group(7.17% vs4.00%),and the differences were both statistically significant(P<0.05).The detection rate of old pulmonary tuberculosis in high risk group was higher than the one in non-high risk group(7.93% vs5.68%),the one in smokers group was higher than the one in non-smokers group(9.30% vs5.06%),and the differences were both statistically significant(P<0.05).The detection rate of nodular goitar in high risk group was higher than the one in non-high risk group(5.58% vs4.94%),there was no significant difference;the one in smokers group was higher than the one in non-smokers group(5.99% vs3.92%),and the difference was statistically significant(P<0.05).There were no significant difference in the detection rate of lung cancer between those with or without pulmonary or other leisions.Conclusion:The detection rate of pulmonary nodule was 49.77%(71.36% for solid nodule,16.41% for non-solid nodule,10.08% for calcified nodule,2.15%for part-solid nodule),those smaller than 5mm in diameter accounted for 61.34% among all pulmonary nodules.The efficacy of LDCT screening for lung cancer is significant,with an advantage over detecting early lung cancer.The detection rate of lung cancer was 1.04% and the rate of lung cancer at stage-I had a proportion for 83.77% in all cases.Adenocarcinoma was the most common pathological type in identified lung cancer,accounting for 96.94%.The detection rate of lung cancer in ?50 years old group was higher than <50 years old group(1.17%vs0.32%)and there was significant difference between them(P<0.05).The detection rate of lung cancer in 60-69 years old group was highest(1.50%).Therefore,more efforts should be paid in lung cancer screenning of people older than 50 years old.Though the detection rate of lung cancer between smokers and non-smokers,the one between secondhand smoke exposure group and no secondhand smoke exposure group were both not significant,there were both distinct statistic difference between them.The education of preventing and screening of lung cancer for smokers and female secondhand smoke exposure individuals should be strengthened.There was significant difference in the detection rate of lung cancer between those who had and did not have direct family history of malignant tumor(2.50% vs 0.61%,P<0.05),more efforts should be paid in lung cancer screenning of people with such family history.The radiation dose was obviously reduced by LDCT.In parallel screening for lung cancer,we should pay more attention to the detection of pulmonary bulla,emphysema and coronary arterial calcification.There were no significant difference in detection rate of lung cancer between those with or without pulmonary or other leisions.There was no significant difference in the detection rate of lung cancer between those who had and did not have environmental or occupational exposure. |
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