18F-FDG PET/CT联合HRCT及血清肿瘤标志物诊断孤立性肺结节的价值

18F-FDG PET/CT Combining with HRCT and Blood Tumor Makers in Diagnosis of Solitary Pulmonary Nodules

目的探讨氟代脱氧葡萄糖(18F-FDG)PET/CT联合高分辨率CT(HRCT)及肿瘤标志物在诊断孤立性肺结节(SPN)的价值方法60例经病理证实SPN患者均接受18F-FDG PET/CT显像和HRCT检查及血清肿瘤标志物[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)、细胞角蛋白片段(CYFR21-1)]检测,所有检查在3天内完成。PET-CT用目测法结合半定量法判断病灶的良恶性,HRCT根据病灶的形态学特征判断其良恶性,用化学发光法测量血清肿瘤标志物(CEA、NSE、SCC、CYFR21-1)。利用McNemar检验分别比较PET/CT+HRCT+肿瘤标志物与PET/CT+HRCT、单独PET/CT、单独HRCT对SPN判断的灵敏度、特异度及准确率。结果60例SPN中45例恶性,15例良性。PET/CT+HRCT+肿瘤标志物三者联合、PET/CT+HRCT二者联合、单独PET/CT、HRCT诊断的准确率分别为92%、83%、73.3%、73%,灵敏度分别为93%、84%、82%、71%,特异度分别为87%、80%、46.6%、80%。PET/CT+HRCT+肿瘤标志物三者联合诊断准确率均高于PET/CT+HRCT二者联合、单独PET/CT、单独HRCT(P均<0.05)。结论18F-FDG PET/CT与HRCT、血清肿瘤标志物三者联合诊断SPN的准确率、灵敏度及特异度较单独PET/CT、HRCT诊断或PET/CT与HRCT二者联合诊断高,值得临床推广。

Objective To explore the value of 18F-FDG PET/CT and HRCT、blood tumor makers in diagnosing solitary pulmonary nodules(SPN).Methods Sixty patients of SPN comfirmed by pathology examined with 18F-FDG PET/CT、HRCT and blood tumor makers(CEA、NSE、SCC、CYFR21-1)in three days.Differential diagnosis of benign and malignant SPN were made using visual method combined with semi-quantitative method on PET/CT and morphological characteristics on HRCT.The serum levels of tumor makers CEA,NSE、SCC、CYFR21-1 were then measured by chemoluminescence method.The results of PET/CT+HRCT+tumor makers、PET/CT+HRCT、PET/CT、HRCT diognosis were compared using McNemar’s Test.Results Forty-five SPN were malignant,and the other fifteen were benign.The ccuracy rate of PET/CT+HRCT+blood tumor makers、PET/CT+HRCT、single PET/CT、HRCT was 92%、83%、73.3%、73%,the sensitivity rate was 93%、84%、82%、71%,the specificity rate was 87%、80%、46.6%、80%,respectively.The accuracy rate of combining PET/CT and HRCT、tumor makers diagnosis were higher than those of PET/CT+HRCT、single PET/CT or HRCT(all P<0.05).Conclusion Combining 18F-FDG PET/CT and HRCT、blood tumor makers(CEA、NSE、SCC、CYFR21-1)has higher sensitivity,specificity and accuracy rate than PET/CT+HRCT、single PET/CT or HRCT;therefore it is worthy to be promoted in clinical practice.