囊液癌胚抗原检测联合液基细胞学检查诊断进展期胰腺囊腺瘤的价值

Value of cyst fluid carcinoembryonic antigen detection combined with liquid based cytology in diagnosing advanced pancreatic cystic neoplasms

目的评价囊液癌胚抗原(CEA)检测、液基细胞学检查及两者联合应用对进展期胰腺囊性肿瘤(A-PCNs)的诊断价值。方法收集2006年1月至2017年6月间上海长海医院行内镜超声下细针穿刺术(EUS-FNA)后囊液分析并进行外科手术获得病理学诊断为PCNs的78例患者的临床资料,其中A-PCNs32例,非A-PCNs46例。比较囊液CEA水平和液基细胞学在A-PCNs和非A-PCNs中是否存在差异;绘制囊液CEA水平的受试者特征曲线(ROC),计算ROC曲线下面积(AUC),评估CEA水平与液基细胞学联合应用对A-PCNs诊断的敏感性、特异性和准确性。结果35例患者中,囊液CEA水平在A-PCNs(9例)和非A-PCNs(26例)两组间差异有统计学意义[(1419.9±1416.9)μg/L比(316.0±475.2)μg/L,P=0.049]。根据ROC曲线分析得出囊液CEA>418.9μg/L可以帮助预测A-PCNs,AUC为0.863,采用该截断值诊断A-PCNs的敏感性、特异性和准确性分别为85.7%、73.1%和75.8%。液基细胞学检测了27例A-PCNs和33例非A-PCNs,阳性率在两组间的差异有统计学意义(48.1%比9.1%,P=0.001),液基细胞学诊断A-PCNs的敏感性、特异性和准确性分别为48.1%、90.9%和55.1%。囊液CEA联合液基细胞学可以有效诊断A-PCNs,其敏感性、特异性和准确性分别为100%、64.7%和76.0%。结论囊液液基细胞和囊液CEA水平对于诊断A-PCNs有一定的价值,两者联合诊断A-PCNs的敏感性和准确性更高。

ObjectiveTo assess the value of carcinoembryonic antigen (CEA) level, liquid based cytology examination and combining 2 methods in predicting advanced pancreatic cystic neoplasms (PCNs).MethodsThe clinical data of 78 patients pathologically confirmed with PCN who underwent surgical resection after EUS-FNA and cyst fluid analysis in Shanghai Changhai Hospital, from January 2006 to June 2017 were collected and analyzed, including 32 (A-PCNs) patients and 46 non A-PCNs patients. The comparisons on the CEA level in the cyst fluid and liquid based cytology between the two groups were performed. ROC curve for CEA level in cyst fluid was applied and under curve area was calculated. Sensitive, specificity and accuracy were applied to assess the diagnosis value of 2 methods in predicting A-PCNs.ResultsIn 35 patients, the difference on cyst fluid CEA level was statistically significant between 9 A-PCNs and 26 non A PCNs patients) [(1419.9±1416.9)μg/L vs (316.0±475.2)μg/L, P=0.049 ]. Based on ROC curve, CEA>418.9 ng/ml could help to predicting A-PCNs with the sensitivity of 85.7%, specificity of 73.1%, and accuracy of 75.8% as the cutoff value, and the area under ROC curve was 0.863. Liquid based cytology were performed in 27 A-PCNs patients and 33 non A PCNs patients, and the positive rate had statistical difference between 2 groups (48.1 vs 9.1%, P=0.001). The sensitivity, specificity and diagnostic accuracy for liquid-based cytology for diagnosing A-PCNs were 48.1%, 90.9%, and 55.1%. Cyst fluid CEA combined with liquid based cytology can effectively diagnose A-PCN, and the sensitivity, specificity, and diagnostic accuracy were 100%, 64.7% and 76.0%.ConclusionsLiquid-based cytology and cyst fluid CEA level were useful in predicting A-PCNs to a certain degree. Combining 2 methods could improve the sensitivity and accuracy in predicting A-PCNs.