^18F-FDG PET/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

The diagnostic efficiency for solitary pulmonary nodules combined ^(18)F-FDG PET/CT imaging with serum tumor markers

目的:评价18F-FDG PET/CT显像联合血清肿瘤标志物检测在孤立性肺结节诊断中的价值。方法:总结2012年7月至2015年7月间的95例孤立性肺结节(SPN)病例,所有结节均行18F-FDG PET/CT扫描及肺癌肿瘤标志物四项组合[癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(SCC)、细胞角蛋白19片段抗原21-1(CYFRA21-1)]检测,所有检测在10天内完成,分别计算18F-FDG PET/CT显像、肺癌肿瘤标志物四项组合、18F-FDG PET/CT联合肺癌肿瘤标志物四项组合3种方法的灵敏性、特异性、精确度、PPV、NPV,并分析病理类型对糖代谢的影响及相互之间的关系。结果:在95例病例中,67例确诊为肺癌,28例为良性病变。单项18F-FDG PET/CT检查的灵敏性、特异性、精确度分别为88.1%、85.7%、87.4%,肺癌肿瘤标志物四项组合诊断分别为35.8%、82.1%和49.5%,联合诊断分别为91.0%、82.1%和88.4%。联合诊断、单项18F-FDG PET/CT诊断SPN灵敏性、精确度显著高于单项肺癌肿瘤标志物四项组合检测(P<0.05),而联合诊断与单独18F-FDG PET/CT诊断相比,特异性低,而灵敏性、精确度高于18F-FDG PET/CT。结论:与单纯肺癌肿瘤标志物四项组合比较,单纯18F-FDG PET/CT显像、联合诊断对SPN诊断价值明显优于前者,肺癌肿瘤标志物四项组合可以作为18F-FDG PET/CT对SPN诊断及鉴别诊断的补充,可为无法获得病理结果的患者提供理想的诊断手段。

Objective： To evaluate the diagnostic efficiency of ^18F-FDG positron emission tomography / computed tomography（PET / CT） plus serum tumor markers for solitary pulmonary nodules.Methods： We retrospectively studied the clinical data of 95 cases with solitary pulmonary nodules（SPN）.These cases underwent ^18F-FDG PET / CT and serum tumor markers（CEA,SCC,CYFRA21-1,NSE） inspections within ten days prior to the operations.The sensitivity,specificity,accuracy,positive predictive value（PPV） and negative predictive value（NPV） and correlations between clinicopathologic features and standard uptake value in maximum（SUVmax） were evaluated,respectively.Results： A total of 67 patients and 28 patients were diagnosed as lung cancer and benign lung diseases,respectively.With regard to SPNs,the sensitivity,specificity,accuracy of the serum tumor markers and ^18F-FDG PET / CT were35.8%,82.1%,49.5% and 88.1%,85.7%,87.4%,respectively.Interestingly,the sensitivity,specificity,accuracy by using tumor markers plus ^18F-FDG PET / CT were 91.0%,82.1% and 88.4%.The sensitivity,accuracy of by using tumor markers plus ^18F-FDG PET / CT or ^18F-FDG PET / CT were significantly higher than sole use of serum tumor markers（p〈0.05）.^18F-FDG PET / CT plus serum tumor markers had lower specificity,but higher sensitivity and accuracy,compared with ^18F-FDG PET / CT alone.Conclusion： The combined use of ^18F-FDG PET / CT and serum tumor markers is contributive to the diagnosis of SPN.