循环肿瘤细胞在低剂量螺旋CT检出孤立性肺结节中的诊断价值

Diagnostic value of circulating tumor cells in solitary pulmonary nodule detected by low-dose helical computed tomography

目的探讨循环肿瘤细胞(CTC)在低剂量螺旋CT(LDCT)检出的孤立性肺结节(SPN)中的诊断价值。方法 2018年7月至2019年5月于福建省立医院胸外科连续收治120例LDCT检出的SPN患者。术前检测CTC,并与癌胚抗原(CEA)比较,以术后病理为SPN良恶性诊断金标准,采用受试者工作特征(ROC)曲线评估CTC在SPN良恶性鉴别中的价值,并采用χ2检验或Fisher确切概率法分析CTC与恶性肺结节临床病理特征间的关系。结果 120例SPN中,经术后病理证实恶性肺结节102例(85%),良性肺结节18例(15%);恶性肺结节CTC明显高于良性肺结节(10.5比7.5 FU/3 ml,Z=-3.834,P<0.01);CTC鉴别SPN良恶性的ROC曲线下面积(AUC)大于CEA,差异有统计学意义(0.784比0.625,P<0.05);CTC截断值为8.15 FU/3 ml时,敏感度78%(79/102),特异度67%(12/18);单因素分析显示CTC与肺腺癌病理分期、淋巴结转移明显相关(χ2=12.894、4.073,P<0.05),与肿瘤最大直径、胸膜侵犯、脉管侵犯无明显相关(χ2=2.044、0.696、1.470,P>0.05)。结论 CTC在LDCT检出的SPN良恶性鉴别上较CEA更具优势,且与临床IA期肺腺癌淋巴结转移及术后TNM分期上调有关。

Objective:To explore the diagnostic value of circulating tumor cells(CTCs)in solitary pulmonary nodule(SPN)detected by low-dose helical computed tomography(LDCT).Methods:120 consecutive patients with SPN detected by LDCT were recruited from Department of Thoracic Surgery in Fujian Provincial Hospital from July 2018 to May 2019.CTCs were detected preoperatively and compared with carcinoembryonic antigen(CEA).The postoperative pathology was taken as the gold standard for diagnosis of benign and malignant SPN.Results:In the 120 cases,102(85%)cases were pathologically diagnosed as malignant nodule,while 18(15%)cases were as benign.The number of CTCs in malignant nodules was significantly greater than that in benign nodules(M=10.5 vs.7.5 FU/3 ml,Z=-3.834,P<0.01).For the differential diagnosis of SPN,the area under the ROC curve(AUC)for CTC was bigger than CEA(AUC=0.784 vs.0.625,P<0.05).When the cut-off value of CTCs was 8.15 FU/3 ml,the sensitivity and specificity were 78%(79/102)and 67%(12/18)respectively.Univariate analysis showed that pathological stage and lymph node metastasis were associated with CTCs in patients with lung adenocarcinoma(χ2=12.894,4.073,P<0.05),and the maximum tumor diameter,pleural invasion and vascular invasion were not significantly correlated with CTCs(χ2=2.044,0.696,1.470,P>0.05).Conclusion:CTC offers potential advantages over CEA in the differential diagnosis of SPN detected by LDCT.CTCs are related to lymph node metastasis and TNM upstaging of clinical stage 1A in lung adenocarcinoma.