美国预防服务工作组 (USPSTF) 制定的肺癌筛查 (LCS) 建议可能会排除一些高受益人群。确定替代标准是否可以识别这些高受益人群。基于模型的预测。美国。人民来自 1997-2014 年国家健康访谈调查 (NHIS)，使用快速节俭的树算法制定替代标准，以及来自 2014-2018 年 NHIS 和 2022 年行为风险因素监测系统，用于比较 USPSTF 标准与替代标准。 LCS 获得的生命年是使用筛查计算机断层扫描 (LYFS-CT) 模型获得的生命年来估计的。 “高效益”被定义为从 3 次年度筛查中平均延长至少 16.2 天的生命，这反映了肺癌风险较高，如果通过筛查发现肺癌，则可显着延长生命。最终的替代标准是 1) 符合以下条件的人每年吸烟任意量至少 40 年，或 2) 年龄在 60 至 80 岁且至少吸烟 40 包年的人。 USPSTF 和替代标准为 LCS 选择了相似数量的人员。与 USPSTF 标准相比，替代标准在识别高受益人群方面具有更高的敏感性（91% vs. 78%；P < 0.001）和特异性（86% vs. 84%；P < 0.001）。对于少数种族和民族，替代标准比 USPSTF 标准提供了更大的敏感性提升（黑人：83% vs. 56% [P < 0.001]；西班牙裔：95% vs. 73% [P = 0.086]；亚洲人：94 % vs. 68% [P = 0.171]）在相似的特异性下。替代标准确定了 USPSTF 标准排除的高风险、高收益群体（吸烟时间≥40年但<20包年且戒烟史>15年的群体），其中许多是种族成员结果基于模型预测。这些结果表明，简单的替代 LCS 标准可以识别更多的高收益人群，特别是在某些种族和民族群体中。退伍军人事务部肺部精准肿瘤学计划。

The recommendation for lung cancer screening (LCS) developed by the U.S. Preventive Services Task Force (USPSTF) may exclude some high-benefit people.To determine whether alternative criteria can identify these high-benefit people.Model-based projections.United States.People from the 1997-2014 National Health Interview Survey (NHIS) to develop alternative criteria using fast-and-frugal tree algorithms and from the 2014-2018 NHIS and the 2022 Behavioral Risk Factor Surveillance System for comparisons of USPSTF criteria versus alternative criteria.Life-years gained from LCS were estimated using the life-years gained from screening computed tomography (LYFS-CT) model. "High-benefit" was defined as gaining an average of at least 16.2 days of life from 3 annual screenings, which reflects high lung cancer risk and substantial life gains if lung cancer is detected by screening.The final alternative criteria were 1) people who smoked any amount each year for at least 40 years, or 2) people aged 60 to 80 years with at least 40 pack-years of smoking. The USPSTF and alternative criteria selected similar numbers of people for LCS. Compared with the USPSTF criteria, the alternative criteria had higher sensitivity (91% vs. 78%; P < 0.001) and specificity (86% vs. 84%; P < 0.001) for identifying high-benefit people. For racial and ethnic minorities, the alternative criteria provided greater gains in sensitivity than the USPSTF criteria (Black: 83% vs. 56% [P < 0.001]; Hispanic: 95% vs. 73% [P = 0.086]; Asian: 94% vs. 68% [P = 0.171]) at similar specificity. The alternative criteria identify high-risk, high-benefit groups excluded by the USPSTF criteria (those with a smoking duration of ≥40 years but <20 pack-years and a quit history of >15 years), many of whom are members of racial and ethnic minorities.The results were based on model projections.These results suggest that simple alternative LCS criteria can identify substantially more high-benefit people, especially in some racial and ethnic groups.U.S. Department of Veterans Affairs Lung Precision Oncology Program.