CT定位下活检联合血清肿瘤标志物检测对周围型肺癌的诊断价值分析

Value of CT-guided biopsy combined with CEA and CYFRA21-1 for the diagnosis of peripheral lung cancer

目的分析CT定位下活检联合癌胚抗原(carcinoembryonic antigen,CEA)及细胞角蛋白19的可溶性片段(soluble fragment of cytokeratin-19)CYFRA21-1检测对周围型肺癌的诊断价值。方法研究对象为2013年1月至2018年4月于泉州海峡医院及厦门长庚医院经影像学检查发现肺部存占位性肿物患者,并有完整CT定位活检穿刺、血清CEA及CYFRA21-1检查及组织学病理病理组织学结果,以病理组织学为金标准,分析CT定位下活检联合CEA及CYFRA21-1检测对周围型肺癌的诊断价值。结果CT定位下活检、CEA、CYFRA21-1单一诊断周围型肺癌的灵敏度分别为95.58%、62.83%、61.06%,特异度分别为85.11%、61.70%、51.06%,准确率分别为92.50%、62.50%、58.13%,阳性预测值分别为93.91%、79.78%、75.00%,阴性预测值分别为88.89%、40.85%、35.29%,kappa值分别为0.816、0.214、0.107;CT定位活检+CEA、CT定位活检+CYFRA21-1、CEA+CYFRA21-1两两组合方式诊断周围型肺癌的灵敏度分别为97.35%、98.13%、84.07%,特异度分别为91.49%、89.36%、72.34%,准确率分别为95.63%、95.63%、80.63%,阳性预测值分别为96.49%、95.69%、87.96%,阴性预测值分别为93.48%、95.45%、65.38%,kappa值0.894、0.893、0.547;三者联合诊断时效能最佳,灵敏度、特异度、准确率、阳性预测值、阴性预测值及kappa值分别为99.12%、97.87%、98.75%、99.12%、97.87%、0.970。结论CT定位下活检联合CEA及CYFRA21-1检测周围型肺癌,可提升诊断效能,值得临床推广。

Objective To analyze the value of biopsy combined with carcinoembryonic antigen(CEA)and soluble fragment of cytokeratin-19(CYFRA21-1)for the diagnosis of peripheral lung cancer. Methods The subjects of the study were the patients who were found to have space-occupied tumor in the lung by magnetic resonance imaging(MRI)in the Quanzhou Strait Hospital and the Xiamen Changgeng Hospital from January 2013 to April 2018.Detection results obtained from CT biopsy puncture,serum CEA,CYFRA21-1 and histopathological examinations were available,with histopathological examination results as the gold standards.The diagnostic value of CT-guided biopsy combined with CEA and CYFRA21-1 for the detection of peripheral lung cancer was analyzed. Results The rates of sensitivity for the diagnosis of peripheral lung cancer by single detection methods of CT-guided biopsy,CEA and CYFRA21-1 were respectively 95.58%,62.83%and 61.06%.The rates of specificity were respectively 85.11%,61.70%and 51.06%.The rates of accuracy were respectively 92.50%,62.50%and 58.13%.The positive predictive values were respectively 93.91%,79.78%and 75.00%,and the negative predictive values were respectively 88.89%,40.85%and 35.29%.The kappa values were respectively 0.816,0.214 and 0.107.The rates of sensitivity for the diagnosis of peripheral lung cancer by combined detection methods of CT-guided biopsy+CEA,CT-guided biopsy+CYFRA21-1 and CEA+CYFRA21-1 were respectively 97.35%,98.13%and 84.07%.The rates of specificity were respectively 91.49%,89.36%and 72.34%.The rates of accuracy were respectively 95.63%,95.63%and 80.63%.The positive predictive values were respectively 96.49%,95.69%and 87.96%,and the negative predictive values were respectively 93.48%,95.45%and 65.38%.The kappa values were respectively 0.894,0.893 and 0.547.The diagnostic efficacy of triple detection was the best,with the rates of sensitivity,specificity,accuracy,positive predictive value,negative predictive value and the kappa value were respectively 99.12%,97.87%,98.75%,99.12%,97.87%and 0.970.Conclusion CT-guided biopsy combined with CEA and CYFRA21-1 for the detection of peripheral lung cancer could enhance diagnostic efficiency,for this reason,it is worth further clinical extension.