According to the NCCN (National Comprehensive Cancer Network) guidelines for lung cancer screening, the application of low-dose spiral CT (LDCT) for routine annual screening in high-risk groups has been found to reduce lung cancer mortality by 20% and reduce mortality from any cause by 7% compared to chest radiograph physical examinations. NCCN guidelines recommend annual low-dose spiral CT of the lungs for people at high risk for lung cancer. High-risk groups are those who are: 1. 55-74 years old, are smoking or have quit smoking for less than 15 years, and have a smoking index greater than 30 pack-years (e.g., 1 pack per day for 30 years). 2. Those older than 50 years of age, with a smoking index greater than 20 pack-years, and a combination of one of the following
History of tumor; history of lung disease; family with lung cancer patients; occupational exposure to radon in residence and carcinogenic substances (including arsenic, chromium, asbestos, nickel, cadmium, beryllium, silica and diesel fumes). The above high-risk groups of lung cancer are recommended to have annual low-dose spiral CT (LDCT) examinations for at least 2 years or until the patient is no longer suitable for complete treatment, while routine LDCT examinations are not recommended for other medium and low-risk groups. Depending on the CT findings, different management measures should be taken: 1. No pulmonary nodules: annual LDCT for at least 2 years or until the patient is no longer suitable for complete treatment. 2. Solid or partially solid pulmonary nodules (nodules without benign calcification, fatty or inflammatory manifestations): (1) <6 mm, annual LDCT for a minimum of 2 years or until the patient is no longer suitable for complete treatment. (2) 6-8 mm, review LDCT at 3 months, and if no growth within 6 months, review LDCT annually for a minimum of 2 years or until the patient is no longer a candidate for complete treatment. (3) >8mm, consider PET/CT examination, if lung cancer is suspected, surgery or biopsy; do not consider lung cancer, review LDCT at 3 months, if no growth within 6 months, review LDCT annually for a minimum of 2 years or until the patient is no longer suitable for complete treatment. The above is under dynamic observation, and if nodal growth is detected, surgical resection is recommended. (4) If an endobronchial nodule is found, LDCT should be repeated after 1 month (immediately if there is a severe cough), and if it does not subside, fiberoptic bronchoscopy should be done for clarification. 3.Ground glass opacity (GGO) or ground glass nodule (GGN) or non-solid nodule in the lung is found.
(GGN), non-solid nodule (Nonsolid nodule NS): (1) <5mm, review CT within 12 months, if stable, annual LDCT for at least 2 years or until the patient is no longer suitable for complete treatment. If enlargement is present, dynamic review of LDCT in 3-6 months or surgical resection may be considered. (2) 5-10mm, review CT within 6 months, if stable, LDCT annually for at least 2 years or until the patient is no longer suitable for complete treatment. (3) >10mm, review LDCT within 3-6 months, and if stable, review LDCT within 6-12 months, or biopsy or surgical resection. If the nodules are found to be enlarged or solid during the above dynamic observation, they should be surgically removed except for those with diameters <5mm, which can be considered for dynamic review of LDCT in 3-6 months.