结肠镜及活检联合血清肿瘤标志物、CT在结肠高级别上皮内瘤变及早期癌变的诊断价值

The value of colonoscopy biopsy,serum tumor markers,and CT in the diagnosis of colorectal polyps and early carcinogenesis

目的探讨结肠镜活检、血清肿瘤标志物、CT对高级别结直肠上皮内瘤变及早期癌变的诊断价值。方法对本院145例结直肠癌患者进行前瞻性研究,其中包括80例结直肠癌和65例高级别上皮内瘤变。所有患者术前均行肿瘤标志物CA199、CA724、癌胚抗原、多层螺旋CT及结肠镜活检。结果结直肠癌组CA199、CA724、癌胚抗原、CT及肿瘤大小值均高于高级别结直肠上皮内瘤变组(P<0.05)。血清肿瘤标志物诊断结直肠癌的受试者工作特征(ROC)曲线下面积为0.750,特异度为72.1%,敏感度为59.2%。螺旋CT诊断结直肠癌的ROC曲线下面积为0.717,特异度为70.2%,敏感度为73.1%。结肠镜诊断结直肠癌的ROC曲线下面积为0.590,特异度为56.3%,敏感度为60.8%。结直肠癌联合诊断的ROC曲线下面积为0.831。肿瘤大小是高级别上皮内瘤变的独立危险因素(P<0.05)。结论结肠镜活检、血清肿瘤标志物、CT对高级别结直肠上皮内瘤变及早期癌变的鉴别诊断有一定价值;肿瘤大小是高级别结直肠上皮内瘤变和癌变的独立危险因素。

Objective To inexplore the diagnostic value of colonoscopy biopsy,serum tumor markers,and CT for high-grade intraepithelial neoplasia and early canceration of colorectal polyps.Methods A total of 145 patients with colorectal polyps in Hangzhou Xixi Hospital were prospectively studied,including 80 cases of colorectal cancer and 65 cases of high-grade intraepithelial neoplasia.All patients underwent tumor markers(CA199,CA724,carcinoembryonic antigen),CT,and colonoscopy biopsy before surgery.Results The values of CA199,CA724,carcinoembryonic antigen,CT,and tumor size in the colorectal cancer group were higher than those in the high-grade intraepithelial neoplasia group(P<0.05).The area under the ROC curve for colonoscopy was 0.590.The specificity was 56.3%,and the sensitivity was 60.8%.The area under the ROC curve of the serum tumor marker was 0.750.The specificity was 72.1%,and the sensitivity was 59.2%.The area under the CT ROC curve was 0.717.The specificity was 70.2%,and the sensitivity was 73.1%.The area under the ROC curve for the combined diagnosis of colorectal cancer was 0.831%.Tumor size was an independent risk factor for high-grade intraepithelial neoplasia(P<0.05).Conclusion Colonoscopy biopsy,serum tumor markers,and CT have a specific value in the differential diagnosis of high-grade intraepithelial neoplasia and early carcinogenesis of colorectal polyps.Tumor size is an independent risk factor for polyps to become cancerous.