血清CA153、TPS、CYFRA21-1检测联合钼靶X摄影在乳腺癌早期诊断中的价值
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摘要
目的探索在乳腺癌诊断中血清糖类抗原153(carbohydrate antigen 153,CA153)、组织多肽特异性抗原(tissue polypeptide specific antigen,TPS)、细胞角质蛋白19片段(cytokeratin 19 fragment antigen 21-1,CYFRA21-1)、钼靶X摄影单独检测和联合检测的临床价值。方法选取2015年1月—2016年12月在唐山市人民医院住院治疗的42例早期乳腺癌患者和42例乳腺良性病变患者,均经组织病理证实,乳腺癌TNM分期为Ⅰ、Ⅱ期的患者30例,Ⅲ、Ⅳ期患者12例。均行钼靶X摄影及CA153、TPS、CYFRA21-1水平检测,然后比较良性组与Ⅰ+Ⅱ期乳腺癌组与Ⅲ+Ⅳ期乳腺癌组血清CA153、TPS、CYFRA21-1水平;比较血清CA153、TPS、CYFRA21-1、钼靶X摄影单项与联合检测结果与病理诊断;比较血清CA153、TPS、CYFRA21-1、钼靶单项检测及联合检测对乳腺癌诊断的价值;通过ROC工作曲线分析诊断试验的价值。结果乳腺癌组患者血清CA153、TPS、CYFRA21-1水平较良性组升高,差异有统计学意义(P<0.05),Ⅲ+Ⅳ期乳腺癌组血清CA153、TPS、CYFRA21-1水平较Ⅰ+Ⅱ期乳腺癌组明显升高,差异有统计学意义(P<0.05)。血清CA153、TPS、CYFRA21-1及钼靶四项联合检测时,灵敏度为80.0%,特异度为94.1%,Youden指数为74.1%,而误诊率为5.9%、漏诊率为20.0%。四项联合的诊断试验曲线下面积(area under the curve,AUC)最大,AUC_(四项联合)>AUC_(CA153+TPS+CYFRA21-1)>AUC_(CYFRA21-1)>AUC_(CA153)>AUC_(TPS)>AUC_(钼靶),曲线下面积差异均有统计学意义(P<0.05)。结论联合检测血清CA153、TPS、CYFRA21-1及钼靶X摄影在乳腺癌早期诊断中具有重要的临床价值。
Objective To explore the clinical value of single and combination detection of CA153, TPS,CYFRA21-1 and molybdenum target X photography in breast cancer diagnosis. Methods Totally 42 patients with early breast cancer and42 patients with breast benign lesions were selected in Tangshan People's Hospital in Jan. 2015-Dec. 2016, which wereconfirmed by histopathologic, TNM staging of breast cancer patients with stage Ⅰ and Ⅱ of 30 patients, 12 patients with stageⅢ and Ⅳ. All patients did molybdenum target X-ray photography and CA153, TPS, CYFRA21-1 level detection, thencompared the serum CA153, TPS, CYFRA21-1 levels of the benign group, Ⅰ + Ⅱ breast cancer group and Ⅲ + Ⅳ breastcancer group; and the the single and combined test results of serum CA153, TPS, CYFRA21-1, molybdenum target Xphotography and the pathological diagnosis were compared; serum CA153, TPS,CYFRA21-1, molybdenum target X singledetection and combined detection of breast cancer diagnosis value were compared; The value of diagnostic test was analyzed byROC working curve. Results The serum CA153, TPS and CYFRA21-1 levels in the breast cancer group were significantlyhigher than the benign group, and the difference was statistically significant(P < 0.05).The serum CA153, TPS and CYFRA21-1 levels of the Ⅲ + Ⅳ breast cancer group were significantly higher than that in the Ⅰ + Ⅱ breast cancer group, and thedifference was statistically significant(P < 0.05).The sensitivity of serum CA153, TPS, CYFRA21-1 and molybdenum targetwas 80.0%, the specificity was 94.1%, the Youden index was 74.1%, and the misdiagnosis rate was 5.9%, and the misseddiagnosis rate was 20.0%.Under the four joint diagnostic test curves, the area was the largest, with the AUC_(the four joint combined)>AUC_(CA153 + TPS + TPS +CYFRA21-1)> AUC_(CYFRA21-1)> AUC_(CA153)> AUC_(TPS)> AUC_(molybdenum target), the area of the curve was statistically significant(P<0.05). Conclusion Combined detection of serum CA153, TPS, CYFRA21-1 and molybdenum target X photography has important clinical value in early diagnosis of breast cancer.
Objective To explore the clinical value of single and combination detection of CA153, TPS,CYFRA21-1 and molybdenum target X photography in breast cancer diagnosis. Methods Totally 42 patients with early breast cancer and42 patients with breast benign lesions were selected in Tangshan People's Hospital in Jan. 2015-Dec. 2016, which wereconfirmed by histopathologic, TNM staging of breast cancer patients with stage Ⅰ and Ⅱ of 30 patients, 12 patients with stageⅢ and Ⅳ. All patients did molybdenum target X-ray photography and CA153, TPS, CYFRA21-1 level detection, thencompared the serum CA153, TPS, CYFRA21-1 levels of the benign group, Ⅰ + Ⅱ breast cancer group and Ⅲ + Ⅳ breastcancer group; and the the single and combined test results of serum CA153, TPS, CYFRA21-1, molybdenum target Xphotography and the pathological diagnosis were compared; serum CA153, TPS,CYFRA21-1, molybdenum target X singledetection and combined detection of breast cancer diagnosis value were compared; The value of diagnostic test was analyzed byROC working curve. Results The serum CA153, TPS and CYFRA21-1 levels in the breast cancer group were significantlyhigher than the benign group, and the difference was statistically significant(P < 0.05).The serum CA153, TPS and CYFRA21-1 levels of the Ⅲ + Ⅳ breast cancer group were significantly higher than that in the Ⅰ + Ⅱ breast cancer group, and thedifference was statistically significant(P < 0.05).The sensitivity of serum CA153, TPS, CYFRA21-1 and molybdenum targetwas 80.0%, the specificity was 94.1%, the Youden index was 74.1%, and the misdiagnosis rate was 5.9%, and the misseddiagnosis rate was 20.0%.Under the four joint diagnostic test curves, the area was the largest, with the AUC_(the four joint combined)>AUC_(CA153 + TPS + TPS +CYFRA21-1)> AUC_(CYFRA21-1)> AUC_(CA153)> AUC_(TPS)> AUC_(molybdenum target), the area of the curve was statistically significant(P<0.05). Conclusion Combined detection of serum CA153, TPS, CYFRA21-1 and molybdenum target X photography has important clinical value in early diagnosis of breast cancer.
引文
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[7]杨娴,徐子魁.数字钼靶X线摄影联合MRI动态增强扫描对含钙化灶乳腺良恶性病变的诊断价值[J].中国中西医结合影像学杂志,2017,15(1):11-14.
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[11]岳璇弟,褚旭.乳腺癌患者血清多项指标与复发转移的相关性研究[J].海南医学院学报,2014,20(8):1120-1122.
[12]何翠兰,李才元,刘翠燕,等.糖尿病伴乳腺癌患者细胞角蛋白19片段抗原21-1水平的变化及其临床意义[J].中国糖尿病杂志,2017,25(3):250-254.
[13]MARRAKCHI R,OUERHANI S,BENAMMAR S,et al.Detection of cytokeratin 19m RNA and CYFRA 21-1(cytokeratin 19fragments)in blood of Tunisian women with breast cancer[J].Int J Biol Markers,2008,23(4):238-243.
[14]刘志勇,欧阳忠,邹小明,等.乳腺癌新的肿瘤标志物-CYFRA21-1[J].江西医药,2010,45(4):299-302.
[15]徐绪党,刘标,杨伟,等.影像学诊断试验的双正态模型参数法ROC曲线分析[J].南京医科大学学报(自然科学版),2014,34(2):230-233.
[16]马志健,蓝永洪,郑艺菲,等.HIF-1α表达与乳腺癌分级及分子亚型的关系研究[J].中国热带医学,2016,16(6):588-590,604.
[17]钟鸣,刘英霞,黄卓雅,等.Pin1和Her2蛋白在乳腺浸润性导管癌中的表达及相关性[J].热带医学杂志,2017,17(10):1293-1296.
[18]吴琼,王堃,向满林,等.可溶性细胞间粘附分子-1在乳腺癌患者血清中表达的临床意义[J].实用预防医学,2016,23(5):630-633.
[2]WANG Z,HAUSER N,SINGER G,et al.Non-invasive classification of microcalcifications with phase-contrast X-ray mammography[J].Nature Communications,2014,15(5):3797.
[3]陈士华.联合检测CA15-3、CA125、CEA对乳腺癌的临床价值探讨[J].检验医学,2013,28(3):235-237.
[4]曾利军,陈建魁,于农,等.血清CEA、CA153和CYFRA21-1联合检测对乳腺癌的诊断价值[J].临床误诊误治,2011,24(6):72-74.
[5]张新毅.乳腺钼靶X射线摄片联合血清CA15-3、CEA和OPN在乳腺癌诊断中的价值[J].中国老年学杂志,2014,34(23):6640-6641.
[6]邱梅婷,秦松树,覃天,等.血清细胞因子及相关受体在乳腺癌中的表达及相关性[J].热带医学杂志,2015,15(3):335-338.
[7]杨娴,徐子魁.数字钼靶X线摄影联合MRI动态增强扫描对含钙化灶乳腺良恶性病变的诊断价值[J].中国中西医结合影像学杂志,2017,15(1):11-14.
[8]BOONLIKIT S.Comparison of mammography in combination with breast ultrasonography versus mammography alone for breast cancer screening in asymptomatic women[J].Asian Pac J Cancer Prev,2013,14(12):7731-7736.
[9]ADAMS J,CARDER P J,DOWNEY S,et al.Vascular endothelial growth factor(VEGF)in breast cancer:comparison of plasma,serum,and tissue VEGF and microvessel density and effects of tamoxifen[J].Cancer Res,2000,60(11):2898-2905.
[10]易琳,刘兴明,林丁,等.血清CA153、CA125、CEA联合检测在乳腺癌诊断中的价值[J].重庆医科大学学报,2012,37(9):802-805.
[11]岳璇弟,褚旭.乳腺癌患者血清多项指标与复发转移的相关性研究[J].海南医学院学报,2014,20(8):1120-1122.
[12]何翠兰,李才元,刘翠燕,等.糖尿病伴乳腺癌患者细胞角蛋白19片段抗原21-1水平的变化及其临床意义[J].中国糖尿病杂志,2017,25(3):250-254.
[13]MARRAKCHI R,OUERHANI S,BENAMMAR S,et al.Detection of cytokeratin 19m RNA and CYFRA 21-1(cytokeratin 19fragments)in blood of Tunisian women with breast cancer[J].Int J Biol Markers,2008,23(4):238-243.
[14]刘志勇,欧阳忠,邹小明,等.乳腺癌新的肿瘤标志物-CYFRA21-1[J].江西医药,2010,45(4):299-302.
[15]徐绪党,刘标,杨伟,等.影像学诊断试验的双正态模型参数法ROC曲线分析[J].南京医科大学学报(自然科学版),2014,34(2):230-233.
[16]马志健,蓝永洪,郑艺菲,等.HIF-1α表达与乳腺癌分级及分子亚型的关系研究[J].中国热带医学,2016,16(6):588-590,604.
[17]钟鸣,刘英霞,黄卓雅,等.Pin1和Her2蛋白在乳腺浸润性导管癌中的表达及相关性[J].热带医学杂志,2017,17(10):1293-1296.
[18]吴琼,王堃,向满林,等.可溶性细胞间粘附分子-1在乳腺癌患者血清中表达的临床意义[J].实用预防医学,2016,23(5):630-633.