Utilidad de la tomografía computarizada de tórax de baja dosis para la tamización de cáncer pulmonar en adultos con factores de riesgo

Alejandra Cañas, Ana Cristina Manzano, Raquel Ramírez, Fredy Ávila, Jennifer Carolina Fajardo

Resumen


Objetivo: presentar los resultados de una revisión sistemática de la literatura médica sobre la tamización con tomografía computarizada de baja dosis para el diagnóstico de cáncer de pulmón en personas adultas sanas con factores de riesgo. Materiales y métodos: se realizó una búsqueda en las bases de datos MEDLINE (In-Process & Other Non-Indexed Citations y Daily Update), EMBASE, The Cochrane Library y LILACS para revisiones sistemáticas, estudios primarios y consulta a expertos clínicos. Se seleccionaron tres revisiones sistemáticas teniendo en cuenta los criterios de inclusión y exclusión establecidos. Se evaluó la calidad de los artículos seleccionados con la metodología GRADE. Resultados: la realización de la tomografía computarizada de baja dosis disminuye el riesgo de morir por cáncer de pulmón en un 20 % en comparación con la radiografía de tórax (Un Estudio Clínico Aleatorizado (ECA) de 53.454 individuos, RR 0,80; IC 95 % de 0,73 a 0,93) con una reducción absoluta de probabilidad de morir por cáncer de pulmón de 0,33 % (87 muertes evitadas/26.722 participantes) y reducción de la mortalidad (Un ECA, 53.454 individuos, RR 0,93; IC 95 % de 0,86 a 0,99) cuando se realiza tomografía computarizada de baja dosis anual, durante tres años. Conclusión: a la fecha la evidencia clínica sugiere que la tamización de personas con factores de riesgo para cáncer de pulmón, con tomografía computarizada de baja dosis reduce la mortalidad. Se deben realizar estudios con un periodo mayor de seguimiento y evaluar la costo-efectividad de esta práctica.

 

The utility of low-dose computed tomography on the screening of lung cancer of high-risk adults

Abstract

Objective: A systematic review on low dose chest computed tomography screening of healthy persons with risk factors for lung cancer was developed. Materials and methods: The search was conducted MEDLINE, EMBASE, The Cochrane Library (CLIB) and LILACS databases for systematic reviews and observational and trial randomized study, besides consultation with clinical experts. Three systematic reviews taking into account the inclusion and exclusion criteria were established. The quality was evaluated using the methodology proposed by GRADE. Results: The studies found suggest that the realization of low-dose computed tomography reduces the risk of dying from lung cancer by 20 % compared with chest radiographs (A Randomized Clinical Trial, 53.454 persons, RR 0,80; IC 95 % 0,73- 0,93), with an absolute reduction of probability of dying from lung cancer of 0.33 % (87 deaths averted /26.722 participants) and mortality reduced (A Randomized Clinical Trial, 53.454 persons, RR 0,93; IC 95 % 0,86- 0,99) when computed tomography is performed in low annual doses for three years. Conclusion: To this date, the medical evidence suggests that the screening of people with risk factors for lung cancer through low-dose computed tomography reduces mortality. Further studies with a longer monitoring period must be done, as well as evaluations of the cost-effectiveness in our field of practice.


Palabras clave


neoplasias pulmonares, efectividad, tamización, diagnóstico temprano de cáncer, tomografía computarizada, Lung neoplasms, Effectiveness, Straining, Early detection of cancer, Tomography

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