社区基于计算机断层扫描筛查肾癌及其他腹部疾病的腹部无对比增强CT扫描：约克郡肾脏筛查试验的结果

约克郡肾脏筛查试验（YKST）评估了在肺癌筛查中加入腹部无对比增强计算机断层扫描（NCCT）以筛查肾癌和其他腹部病变的可行性。一项前瞻性诊断研究向参加英国随机肺癌筛查试验的55-80岁曾吸烟者提供腹部NCCT（2021年5月至2022年10月）。排除标准包括痴呆、虚弱、既往肾癌/肺癌以及在前6或12个月内进行的腹部和胸部CT扫描。进行了6个月的随访。共有4438人接受肺部筛查，其中4309人（97%）符合条件并接受了腹部NCCT，只有3.9%的受访者对参与表示后悔。进行YKST流程所需的额外时间为13.3分钟。参与者中，2586人（64%）的腹部NCCT正常，787人（20%）需进行影像评审但无需进一步处理，611人（15%）则需进一步评估（检查和/或门诊）。其中，211人（5.3%）发现新的严重异常，包括25人（0.62%）具有肾脏肿块/复杂囊肿，10人（0.25%）经组织学证实患有肾癌；10人（0.25%）患有其他癌症；60人（1.5%）存在腹主动脉瘤（AAA）。25人（0.62%）接受了治愈性治疗。非严重发现共计1017人（25%），其中最常见的是良性肾囊肿（727人，占18%），只有259人（6.4%）需要进一步检测。检测一例严重腹部异常所需筛查人数为18人，检测一例疑似肾病变为93人，检测一例组织学确诊的肾癌为402人。该队列的局限性包括年龄范围固定及为先前接受肺癌筛查的受试者。在首次结合胸部CT的腹部NCCT前瞻性风险分层筛查研究中，参与率和满意度均较高。严重异常、癌症和AAA的患病率与结肠癌等已建立筛查项目类似。今后应评估长期结果及成本效益。

The Yorkshire Kidney Screening Trial (YKST) assessed the feasibility of adding abdominal noncontrast computed tomography (NCCT) to lung cancer screening to screen for kidney cancer and other abdominal pathology.A prospective diagnostic study offered abdominal NCCT to 55-80-yr-old ever-smokers attending a UK randomised lung cancer screening trial (May 2021 to October 2022). The exclusion criteria were dementia, frailty, previous kidney/lung cancer, and computed tomography (CT) of the abdomen and thorax within previous 6 and 12 mo, respectively. Six-month follow-up was undertaken.A total of 4438 people attended lung screening, of whom 4309 (97%) were eligible for and 4019 (93%) accepted abdominal NCCT. Only 3.9% respondents regretted participating. The additional time to conduct the YKST processes was 13.3 min. Of the participants, 2586 (64%) had a normal abdominal NCCT, whilst 787 (20%) required an abdominal NCCT imaging review but no further action and 611 (15%) required further evaluation (investigations and/or clinic). Of the participants, 211 (5.3%) had a new serious finding, including 25 (0.62%) with a renal mass/complex cyst, of whom ten (0.25%) had histologically proven kidney cancer; ten (0.25%) with other cancers; and 60 (1.5%) with abdominal aortic aneurysms (AAAs). Twenty-five (0.62%) participants had treatment with curative intent. Of the participants, 1017 (25%) had nonserious findings, most commonly benign renal cysts (727 [18%]), whereas only 259 (6.4%) had nonserious findings requiring further tests. The number needed to screen to detect one serious abdominal finding was 18; it was 93 to detect one suspicious renal lesion and 402 to detect one histologically confirmed renal cancer. Limitations of the cohort were fixed age range and being prior lung cancer screening attendees.In this first prospective risk-stratified screening study of abdominal NCCT offered alongside CT thorax, uptake and participant satisfaction were high. The prevalence of serious findings, cancers, and AAAs, is in the range of established screening programmes such as bowel cancer. Longer-term outcomes and cost effectiveness should now be evaluated.