CT特征联合癌胚抗原对磨玻璃结节的浸润前和浸润性鉴别诊断价值的研究

The Value of CT Features Combined with Carcinoembryonic Antigen in Differential Diagnosis of Infiltration and Invasiveness of Ground Glass Nodule

目的通过对磨玻璃结节(GGN)的CT特征及癌胚抗原(CEA)浓度值的比较,探讨CT特征联合CEA浓度值鉴别诊断GGN是否属于浸润前或浸润性病变的临床价值。方法回顾分析106例GGN,其中浸润前病变54例,浸润性病变51例,对病灶的CT特征进行测量、比较。其特征包括:病灶的分叶征和胸膜凹陷征,CEA的浓度值。结果浸润性病变中出现分叶征48例(94.12%)、胸膜凹陷征33例(64.71%),其阳性率明显高于浸润前病变的分叶征(22.22%)及胸膜凹陷征(11.11%),两者之间的差异有统计学意义(P<0.05)。分叶征和胸膜凹陷征诊断浸润性病变的灵敏度分别87.6%和58.8%;特异度分别72.3%和75.8%。CEA最佳阈值为1.72ng/ml,其诊断浸润性病变的灵敏度和特异度分别70.6%和66.7%。考虑将两者联合,其诊断的灵敏度和特异度明显提高,其中CEA联合分叶征最为显著,分别为90.7%、81.3%。结论应用CT获得的分叶征、胸膜凹陷征及CEA浓度值对鉴别GGN是否属于浸润前或浸润性病变有一定的临床价值。推荐CEA浓度值≥1.72ng/ml与病灶的分叶征联合诊断GGN的浸润性病变,以提高诊断的灵敏度。

Objective To compare the CT features of the ground glass nodule(GGN)and the concentration of carcinoembryonic antigen(CEA),to explore whether CT features combined with CEA concentration to diagnose GGN was a pre-invasive or invasive disease.Methods A retrospective analysis of 106 cases of GGN,including 54 cases of preinvasive lesions,51 cases of invasive lesions,measured and compared the CT features of the lesions.Its characteristics included:the lobulated sign of the lesion and the pleural indentation sign,the concentration value of CEA.Results There were 48 cases(94.12%)with lobular sign and 33 cases(64.71%)with pleural indentation in invasive lesions.The positive rate was significantly higher than that of pre-invasive lesions(22.22%)and pleural indentation(11.11%),the difference between the two was statistically significant(P<0.05).The sensitivity of lobulated sign and pleural indentation for the diagnosis of invasive lesions was 87.6%and 58.8%,respectively;the specificity was 72.3%and 75.8%,respectively.The optimal threshold for CEA was 1.72 ng/ml,and the sensitivity and specificity of the diagnosis of invasive lesions were 70.6%and 66.7%,respectively.Considering the combination of the two,the sensitivity and specificity of the diagnosis were significantly improved,and the CEA combined with the lobulation sign was the most significant,90.7%and 81.3%respectively.Conclusion The lobulated sign,pleural indentation and CEA concentration obtained by CT.It had certain clinical value for identifying whether GGN belongs to pre-invasive or invasive lesions.It was recommended that the CEA concentration value≥1.72 ng/ml combined with the lobulated sign of the lesion to diagnose invasive lesions of GGN to improve the sensitivity of the diagnosis.