社区基础CT筛查肺癌时加入腹部非对比CT扫描以筛查肾癌及其他腹部疾病的可行性：约克郡肾脏筛查试验结果

约克郡肾脏筛查试验（YKST）评估了在肺癌筛查中加入腹部非对比CT（NCCT）以筛查肾癌及其他腹部疾病的可行性。一项前瞻性诊断研究为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、以及在过去6或12个月内进行的腹部和胸部CT。进行了6个月的随访。共计4438人参加肺部筛查，其中4309人（97%）符合条件，4019人（93%）接受腹部NCCT。只有3.9%的受试者后悔参与。进行YKST所用额外时间为13.3分钟。结果显示，64%的受试者腹部NCCT正常（2586人），20%（787人）仅需影像审查无需进一步行动，15%（611人）需进一步评估（检查和/或门诊）。发现中，211人（5.3%）具有新的严重异常，包括25人（0.62%）存在肾块/复杂囊肿，其中10人（0.25%）经组织学证实为肾癌；10人（0.25%）存在其他癌症；60人（1.5%）患有腹主动脉瘤（AAA）。其中25人（0.62%）接受了治愈性治疗。非严重异常发现者1017人（25%），最常见为良性肾囊肿（727人，18%），而仅有259人（6.4%）需进一步检测。筛查发现一例严重腹部异常的人数为18，检测一例可疑肾病变为93，确诊一例组织学肾癌为402。研究局限在于年龄范围固定且为先前肺癌筛查的受试者。作为首次在CT胸部筛查中同步提供腹部NCCT的前瞻性风险分层筛查研究，参与率和满意度均较高。严重异常、癌症和AAA的检出率与结直肠癌等已建立的筛查项目相当。未来应评估长期效果和成本效益。

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.