HRCT联合肿瘤标志物诊断孤立性肺结节的临床价值
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摘要
目的探讨高分辨率CT(high-resolution CT,HRCT)联合血清肿瘤标志物在诊断孤立性肺结节(solitary pulmonary nodule,SPN)中的临床价值。方法 126例恶性SPN患者为观察组,98例良性SPN患者为对照组,进行血清肺癌肿瘤标志物4项组合:癌胚抗原(carcino-embryonic antigen,CEA)、鳞状上皮细胞癌抗原(squamous cell carcinoma,SCC)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、细胞角蛋白19片段抗原21-1(cytokeratin-19-fragment 21-1,CYFRA21-1)检测和HRCT检测,以病理检测结果为金标准,评价HRCT检查、血清肿瘤标志物检测及两者联合检测的敏感度、特异度、准确度、阳性预测值和阴性预测值。结果 SPN病理检测结果:腺癌59例,鳞癌42例,细支气管肺泡癌16例,小细胞癌9例。在HRCT征象上,恶性组在典型结节并深分叶、胸膜凹陷、短细毛刺、空泡征、支气管血管集束征、棘状突起的检出率高于良性组,良性组在相邻胸膜增厚和卫星灶的检出率高于恶性组,差异均有统计学意义(P<0.05)。恶性组血清CEA、SCC、NSE、CYFRA21-1浓度均高于良性组,差异均有统计学意义(P<0.05)。3种检查方法中联合检查敏感度最高,但是其特异度是最低的;准确度以肿瘤标志物最低,HRCT与联合检查相近;阳性预测值以HRCT最高,阴性预测值以肿瘤标志物检测方法最低。结论联合检查敏感度最高,特异度最低,应注意假阳性率的鉴别,综合评价各项指标,HRCT检查中各项指标均较恒定,在临床中有较高的诊断价值;肿瘤标志物检测结合HRCT检查将大大提高诊断价值,值得临床推广。
Objective To study the effect of high-resolution CT(HRCT) combined with serum tumor markers detection in diagnose of solitary pulmonary nodule(SPN). Methods One hundred and twenty-six cases of malignant SPN patients were selected as observation groups, 98 cases of benign SPN patients from the same time were selected as control group. Serum lung cancer markers were combined into four groups:carcino embryonic antigen(CEA), squamous cell carcinoma(SCC), neuron-specific enolase(NSE), cytokeratin-19-fragment 21-1(CYFRA21-1) detection and HRCT detection. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HRCT, serum tumor markers and their combined detection were evaluated according to the gold standard of pathological results. Results SPN pathological results showed that 59 cases of adenocarcinoma, 42 cases of squamous cell carcinoma, 16 cases of bronchioloalveolar carcinoma and 9 cases of small cell carcinoma. On HRCT signs, the detection rates of typical nodules with deep lobulation, pleural depression, short and fine spikes, vacuole sign, bronchial vascular cluster sign and spinous process in malignant group were higher than those in benign group, while the detection rates of adjacent pleural thickening and satellite oven in benign group were higher than those in malignant group(P<0.05). The levels of serum CEA, SCC, NSE and CYFRA21-1 in malignant group were higher than those in benign group(P<0.05). The sensitivity of combined examination was the highest among the three methods, but the specificity was the lowest, the accuracy of tumor markers was the lowest, HRCT and combined examination were similar; the positive predictive value of HRCT was the highest, and the negative predictive value was lowest with the detection of tumor markers. Conclusion Joint examination has the highest sensitivity and the lowest specificity. We should pay attention to the identification of false positive rate, comprehensive evaluation of various indicators, HRCT examination indicators are relatively constant, and have higher diagnostic value in clinic. Detection of tumor markers combined with HRCT examination will greatly improve the diagnostic value, which is worthy of clinical promotion.
Objective To study the effect of high-resolution CT(HRCT) combined with serum tumor markers detection in diagnose of solitary pulmonary nodule(SPN). Methods One hundred and twenty-six cases of malignant SPN patients were selected as observation groups, 98 cases of benign SPN patients from the same time were selected as control group. Serum lung cancer markers were combined into four groups:carcino embryonic antigen(CEA), squamous cell carcinoma(SCC), neuron-specific enolase(NSE), cytokeratin-19-fragment 21-1(CYFRA21-1) detection and HRCT detection. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of HRCT, serum tumor markers and their combined detection were evaluated according to the gold standard of pathological results. Results SPN pathological results showed that 59 cases of adenocarcinoma, 42 cases of squamous cell carcinoma, 16 cases of bronchioloalveolar carcinoma and 9 cases of small cell carcinoma. On HRCT signs, the detection rates of typical nodules with deep lobulation, pleural depression, short and fine spikes, vacuole sign, bronchial vascular cluster sign and spinous process in malignant group were higher than those in benign group, while the detection rates of adjacent pleural thickening and satellite oven in benign group were higher than those in malignant group(P<0.05). The levels of serum CEA, SCC, NSE and CYFRA21-1 in malignant group were higher than those in benign group(P<0.05). The sensitivity of combined examination was the highest among the three methods, but the specificity was the lowest, the accuracy of tumor markers was the lowest, HRCT and combined examination were similar; the positive predictive value of HRCT was the highest, and the negative predictive value was lowest with the detection of tumor markers. Conclusion Joint examination has the highest sensitivity and the lowest specificity. We should pay attention to the identification of false positive rate, comprehensive evaluation of various indicators, HRCT examination indicators are relatively constant, and have higher diagnostic value in clinic. Detection of tumor markers combined with HRCT examination will greatly improve the diagnostic value, which is worthy of clinical promotion.
引文
[1] 周清华,范亚光,王颖,等.中国肺部结节分类、诊断与治疗指南(2016年版)[J].中国肺癌杂志,2016,19(12):793-798.
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[4] 朱涛,林岩,孙海斌.血清THS、NSE、CEA联合检测与小细胞肺癌的临床关系[J].河北医科大学学报,2012,33(9):1035-1038.
[5] Pang L,Wang J,Jiang Y,et al.Decreased levels of serum cytokeratin 19 fragment CYFRA 21-1 predict objective response to chemotherapy inpatients with non-small cell lung cancer[J].Exp Ther Med,2013,6(2):355-360.
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[9] 张怀信,周伟,蒋雪峰.良恶性肺部孤立局灶性磨玻璃密度结节CT征象及其临床诊断价值[J].河北医科大学学报,2016,37(12):1458-1461.
[10] Mao H,Labh K,Han F,et al.Diagnosis of the invasiveness of lung adenocarcinoma manifesting as ground glass opacities on high-resolution computed tomography[J].Thoracic Cancer,2016,7(1):129-135.
[11] 陈颖,胡春洪,林盪,等.多排螺旋CT薄层重组和高分辨率CT靶扫对肺微小结节的价值比较[J].临床放射学杂志,2017,36(11):1617-1622.
[12] 李笑莹,刘芳,车海杰,等.肿瘤标志物预测孤立性肺结节恶性概率模型的建立与初步评价[J].山东大学学报:医学版,2017,55(4):60-64.
[13] 刘晓飞,李鹏程,何宝明,等.18F-FDG ET/CT显像联合血清肿瘤标志物组合在孤立性肺结节诊断中的价值[J].现代肿瘤医学,2017,25(8):1230-1234.
[14] Chen F,Wang XY,Han XH,et al.Diagnostic value of Cyfra21-1,SCC and CEA for differentiation of early-stage NSCLC from benign lung disease[J].Int J Clin Exp Med,2015,8(7):11295-11300.
[15] Wang H,Zhang X,Liu X,et al.Diagnostic value of bronchoalveolar lavage fluid and serum tumor markers for lung cancer[J].J Cancer Res Ther,2016,12(1):355-358.
[16] 奚小祥,吕必宏,何光明,等.孤立性肺结节早期诊治的临床策略[J].中国胸心血管外科临床杂志,2014,21(6):793-798.
[2] 王琳,吴传勇,娄加陶.肿瘤标记物检测在肺部孤立性结节鉴别诊断中的价值[J].现代免疫学,2016,36(5):405-409.
[3] 中华医学会呼吸病学分会肺癌学组,中国肺癌防治联盟专家组.肺部结节诊治中国专家共识[J].中华结核和呼吸杂志,2015,38(4):249-254.
[4] 朱涛,林岩,孙海斌.血清THS、NSE、CEA联合检测与小细胞肺癌的临床关系[J].河北医科大学学报,2012,33(9):1035-1038.
[5] Pang L,Wang J,Jiang Y,et al.Decreased levels of serum cytokeratin 19 fragment CYFRA 21-1 predict objective response to chemotherapy inpatients with non-small cell lung cancer[J].Exp Ther Med,2013,6(2):355-360.
[6] Soubani AO.The evaluation and management of the solitary pulmonary nodule[J].Postgrad Med J,2008,84(995):459-466.
[7] Slatore CG,Horeweg N,Jett JR,et al.An official American Thoracic Society research statement:a research framework for pulmonary nodule evaluation and management[J].Am J Respir Crit Care Med,2015,192(4):500-514.
[8] Naidich DP,Bankier AA,MacMahon H,et al.Recommendations for the management of subsolid pulmonary nodules detected at CT:a statement from the fleischner society[J].Radiology,2013,266(1):304-317.
[9] 张怀信,周伟,蒋雪峰.良恶性肺部孤立局灶性磨玻璃密度结节CT征象及其临床诊断价值[J].河北医科大学学报,2016,37(12):1458-1461.
[10] Mao H,Labh K,Han F,et al.Diagnosis of the invasiveness of lung adenocarcinoma manifesting as ground glass opacities on high-resolution computed tomography[J].Thoracic Cancer,2016,7(1):129-135.
[11] 陈颖,胡春洪,林盪,等.多排螺旋CT薄层重组和高分辨率CT靶扫对肺微小结节的价值比较[J].临床放射学杂志,2017,36(11):1617-1622.
[12] 李笑莹,刘芳,车海杰,等.肿瘤标志物预测孤立性肺结节恶性概率模型的建立与初步评价[J].山东大学学报:医学版,2017,55(4):60-64.
[13] 刘晓飞,李鹏程,何宝明,等.18F-FDG ET/CT显像联合血清肿瘤标志物组合在孤立性肺结节诊断中的价值[J].现代肿瘤医学,2017,25(8):1230-1234.
[14] Chen F,Wang XY,Han XH,et al.Diagnostic value of Cyfra21-1,SCC and CEA for differentiation of early-stage NSCLC from benign lung disease[J].Int J Clin Exp Med,2015,8(7):11295-11300.
[15] Wang H,Zhang X,Liu X,et al.Diagnostic value of bronchoalveolar lavage fluid and serum tumor markers for lung cancer[J].J Cancer Res Ther,2016,12(1):355-358.
[16] 奚小祥,吕必宏,何光明,等.孤立性肺结节早期诊治的临床策略[J].中国胸心血管外科临床杂志,2014,21(6):793-798.