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Rofo 2021; 193(06): 644-651
DOI: 10.1055/a-1290-7817
Review

Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 – Key Elements for Programmatic Implementation of Lung Cancer Screening

Lungenkrebs-Screening mittels Niedrigdosis-Computertomografie Teil 2 – Essenzielle Elemente für eine Implementierung eines Lungenkrebs-Screening-Programms
Stefan Delorme
1   Division of Radiology, German Cancer Research Centre, Heidelberg, Germany
,
Rudolf Kaaks
2   Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
3   Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Germany
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Abstract

Purpose For screening with low-dose CT (LDCT) to be effective, the benefits must outweigh the potential risks. In large lung cancer screening studies, a mortality reduction of approx. 20 % has been reported, which requires several organizational elements to be achieved in practice.

Materials and Methods The elements to be set up are an effective invitation strategy, uniform and quality-assured assessment criteria, and computer-assisted evaluation tools resulting in a nodule management algorithm to assign each nodule the needed workup intensity. For patients with confirmed lung cancer, immediate counseling and guideline-compliant treatment in tightly integrated regional expert centers with expert skills are required. First, pulmonology contacts as well as CT facilities should be available in the participant’s neighborhood. IT infrastructure, linkage to clinical cancer registries, quality management as well as epidemiologic surveillance are also required.

Results An effective organization of screening will result in an articulated structure of both widely distributed pulmonology offices as the participants’ primary contacts and CT facilities as well as central expert facilities for supervision of screening activities, individual clarification of suspicious findings, and treatment of proven cancer.

Conclusion In order to ensure that the benefits of screening more than outweigh the potential harms and that it will be accepted by the public, a tightly organized structure is needed to ensure wide availability of pulmonologists as first contacts and CT facilities with expert skills and high-level equipment concentrated in central facilities.

Key Points: 

  • For lung cancer screening, elements must function optimally and be tightly organized.

  • Lung cancer screening requires a network of expert centers and collaborating facilities.

  • IT infrastructure, QM, epidemiological surveillance, and linkage to cancer registries are essential.

Citation Format

  • Delorme S, Kaaks R: Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 – Key Elements for Programmatic Implementation of Lung Cancer Screening. Fortschr Röntgenstr 2021; 193: 644 – 651

Zusammenfassung

Ziel In einem erfolgreichen Lungenkrebs-Screening mit Niedrigdosis-CT (Low-Dose-CT, LDCT) müssen die Vorteile für die Teilnehmer die möglichen Risiken überwiegen. Die Senkung der Lungenkrebsmortalität in großen Screening-Studien betrug ca. 20 %. Um dies zu erzielen, müssen bei der Umsetzung eine Vielzahl organisatorischer Voraussetzungen erfüllt werden.

Material und Methoden Wichtigste Elemente sind ein effektives Einladungsverfahren, einheitliche und qualitätsgesicherte Kriterien und computergestützte Auswertungsverfahren zur Etablierung eines algorithmischen Verfahrens, das jedem Herdbefund die angemessene Intensität des Abklärungsverfahrens zuweist. Für Patienten mit nachgewiesenem Lungenkrebs ist die Verfügbarkeit unmittelbarer Beratung und leitliniengerechter Therapie in eng eingebunden Referenzzentren unabdingbar. Pneumologische Einrichtungen für Erstkontakt und klinische Betreuung der Teilnehmer sowie CT-Einrichtungen müssen wohnortnah verfügbar sein. Weitere Anforderungen sind IT-Infrastruktur, Anbindung an klinische Krebsregister, Qualitätsmanagement und epidemiologische Überwachung.

Ergebnisse Eine effektive Organisation des Screenings gewährleistet eine verzahnte Struktur aus wohnortnahen pneumologischen Einrichtungen als primäre Kontakte für die Teilnehmer und Referenzzentren, denen neben der Supervision der Screening-Aktivitäten die individuelle Abklärungsdiagnostik suspekter Befunde und die Behandlung nachgewiesener Bronchialkarzinome obliegt.

Schlussfolgerungen Um zu gewährleisten, dass der Nutzen des Screenings dessen möglichen ungünstigen Auswirkungen überwiegt, und damit es akzeptiert wird, ist eine dicht organisierte Struktur erforderlich, die zugleich eine breite Verfügbarkeit von pneumologischen Kontakten und CT-Einrichtungen und in Zentren integrierte Expertise und moderne Medizintechnik gewährleistet.

Kernaussagen: 

  • Lungenkrebs-Screening erfordert optimal funktionierende und eng abgestimmte Abläufe.

  • Lungenkrebs-Screening erfordert eine Netzwerkstruktur aus Expertenzentren und kooperierenden Einrichtungen.

  • IT-Infrastruktur, QM, epidemiologische Überwachung und Anbindung an Krebsregister sind essenziell.

Key words

screening - lung neoplasms - computed tomography


Publication History

Received: 10 July 2020

Accepted: 29 September 2020

Article published online:
19 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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