PET/CT联合CEA、CA125、CY21-1、NSE对单发性肺部占位性病变鉴别诊断价值的研究

The value of PET/CT combined with CEA,CA125,CY21-1 and NSE in differential diagnosis of solitary pulmonary occupying lesions

目的探讨正电子计算机断层扫描(PET/CT)联合癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角蛋白19片段(CY21-1)、神经元性特异性烯醇化酶(NSE)对单发性肺部占位性病变的鉴别诊断价值。方法收集2015年4月-2018年2月乐山市人民医院收治的243例肺部占位性病变患者为研究对象。所有患者均在术前10d完成PET-CT及血清肿瘤标志物检查,与组织病理学结果比较,对比分析单纯肿瘤标志物检测、PET-CT检测、联合检测3种方式对单发性肺部占位性病变的诊断价值。结果 (1)243例患者,最终经病理确诊肺癌195例,良性病变48例。肿瘤标志物检测的特异度、灵敏度、准确率分别为72.9%、62.1%、64.2%;PET-CT检测为47.9%、91.3%、82.7%;联合检测分别为45.8%、97.4%、87.3%。肿瘤标志物检测特异度最高,但准确率最低。PET-CT检测灵敏度最高。联合检测准确率最高,但特异度最低。(2)随着肿瘤直径增大,3种检测方式的准确性均逐渐提高。对于直径≤2cm、~3cm、~5cm、>5cm的肿瘤,均为肿瘤标志物检测方式的ROC曲线下面积最小,PET-CT检测次之,联合检测最大。(3)吸烟史、肿瘤最大径、淋巴结转移是影响PET-CT(SUVmax)的独立性危险因素(P<0.05)。对PET-CT SUVmax影响大小依次为肿瘤最大直径>淋巴结转移>吸烟史。(4)PET-CT SUVmax与患者性别(r=—0.189,P=0.008)、肺癌最大直径(r=0.499,P=0.000)、肺良性肿瘤最大直径(r=0.328,P=0.001)、吸烟史(r=0.208,P=0.002)、解剖学位置(r=—0.616,P=0.000)、淋巴结转移(r=0.210,P=0.003)、病理分期(r=0.333,P=0.000)呈明显的相关关系。结论 PET/CT联合CEA、CA125、CY21-1、NSE可有效提高对单发性肺癌的诊断效能,对临床上无法通过创伤性检查获得病理诊断的患者有一定的辅助诊断价值。

Objective To evaluate the value of positron computed tomography（PET/CT）combined with carcinoembryonic antigen（CEA）,carbohydrate antigen 125（CA125）,cytokeratin 19 fragment（CY21-1）,neuron specific enolization.Methods A total of 243 patients with pulmonary space-occupying lesions admitted to our hospital from April 2015 to February 2018 were enrolled.All patients were examined PETCT and serum tumor markers,10 days before surgery.The diagnostic value of the histopathological,comparative analysis of simple tumor marker detection,PET-CT detection,combined detection of three ways was analyzed.Results（1）Among 243 patients,there were 195 lung cancer cases and 48 benign cases.The specificity,sensitivity and accuracy of tumor marker detection,PET-CT and combined detection were72.9%,62.1%,64.2%,47.9%,91.3%,82.7%,45.8%,97.4%,87.3%,respectively.The specificity of tumor markers detection method was the highest,but its accuracy was the lowest.The sensitivity of PETCT was the highest.The accuracy of combined detection was the highest,but its specificity was the lowest.（2）As the diameter of the tumor increases,the accuracy of the three detection methods gradually increases.For tumors with diameters less than or equal to 2 cm,3 cm,5 cm,and5 cm,the area under the ROC curve for tumor marker detection was the smallest.And the combined detection was the largest.（3）Smoking history,tumor maximum diameter,and lymph node metastasis were independent risk factors for PET-CT（SUVmax）（P 0.05）.The effect on PET-CT SUVmaxwas as follows：tumor maximum diameterlymph node metastasissmoking history.（4）PET-CT SUVmaxand patient gender（r=-0.189,P=0.008）,lung cancer maximum diameter（r=0.499,P =0.000）,lung benign tumor maximum diameter（r=0.328,P =0.001）,smoking History（r=0.208,P =0.002）,anatomical position（r=-0.616,P =0.000）,lymph node metastasis（r=0.210,P =0.003）,pathological stage（r=0.333,P =0.000）were significant relevant relationship.Conclusion PET/CT combined with CEA,CA125,CY21-1,NSE can effectively improve the diagnostic efficacy of single lung cancer,and it has certain auxiliary diagnostic value for patients who cannot obtain pathological diagnosis by traumatic examination.