^(18)氟脱氧葡萄糖符合线路显像结合血清肿瘤标志物诊断肺部肿块的价值

The diagnostic value of FDG coincidence imaging combined with serum tumor marker assays for pulmonary lesions

目的评价18氟脱氧葡萄糖(18F-FDG)符合线路断层显像结合血清肿瘤标志物测定对肺部肿块良恶性鉴别的应用价值,并对两种方法进行比较。方法对104例胸部X线或CT怀疑肺癌的患者行18F-FDG符合线路显像及癌胚抗原(CEA)、细胞角蛋白片段(CYFRA21-1)和神经元特异性烯醇化酶(NSE)检测,两种检查在1周内全部完成。对肺部病变的18F-FDG浓聚程度及特征进行分析,以局部斑块状放射性异常浓聚灶为阳性(肺癌);无明显放射性浓聚或浓聚呈云片状、散在性模糊的影像为阴性(良性)。三项肿瘤标志物中有1项或1项以上超过正常值上限即为阳性(肺癌)。上述检查完成后1个月内得到病理等最终诊断结果。结果66例患者确诊为肺癌,38例为肺部良性病变。18F-FDG符合线路显像对肺癌诊断的灵敏度、特异性和准确性分别为80．0％、77．2％和77．9％;血清肿瘤标志物对肺癌诊断的灵敏度、特异性和准确性分别为56．0％、60．9％和64．4％。统计结果显示,18F-FDG符合线路显像对肺癌诊断的灵敏度、特异性和准确性均明显优于血清肿瘤标志物测定。在5例18F-FDG符合线路显像检查假阴性的肺癌患者中,有4例血清肿瘤标志物测定为阳性,提示后者对肺癌的诊断仍有一定的参考价值。结论18F-FDG符合线路显像结合血清肿瘤标志物测定有助于提高肺癌诊断的阳性率。

Objective To evaluate the performance of ^18F-FDG three-head tomography with coincidence imaging and serum tumor marker assays in identifying lung lesions in 104 patients with abnormal findings on chest X-ray or computer tomography. Methods A prospective evaluation of ^18F-FDG coincidence imaging and the measurement of 3 serum markers for lung cancer （ carcinoembryonic antigen, CYFRA21-1 and neuron specific enolase） were performed within one week in 104 inpatients with suspected lung malignancy. All images were analyzed visually. It was considered positive for malignancy if the ^18F-FDG uptake was increased relative to that in the adjacent lung tissue, and was focal. The serum tumor marker test was considered positive for malignancy if the serum level of at least one marker was elevated. Results 66 patients were proven to have lung cancer by pathology, and 38 patients had benign lung diseases. The sensitivity, specificity, accuracy of ISF-FDG coincidence imaging and serum tumor markers in assessing lung cancers were 80.0% , 77.2% , 77.9% and 56.0% , 60.9% ,64.4% , respectively. ^18F-FDG coincidence images in assessing lung lesions showed significantly higher sensitivity, specificity and accuracy than serum tumor markers. Four patients with lung cancer had negative findings on ^18F-FDG coincidence images but showed positive serum markers. Conclusion ^18F-FDG coincidence imaging is a powerful tool for evaluating patients with lung lesions suggestive of malignancy. Although the determination of serum marker levels is less accurate than ^18F-FDG coincidence imaging, the combination of a positive ^18F-FDG coincidence result and positive tumor markers may be helpful in improving the diagnosis of lung cancers.