高危人群低剂量CT与肿瘤标志物联合检查早期肺癌的效能研究

Diagnostic Value of LDCT Combined with Tumor Markers in Early Stage Lung Cancer among High-risk Population

目的探讨低剂量螺旋CT(low dose spiral computed tomography,LDCT)扫描联合细胞角质蛋白片段21-1(CYFRA21-1)、鳞状上皮细胞癌抗原(SCC)、神经特异性烯醇化酶(NSE)、胃泌素释放肽前体(GRP)、癌胚抗原(CEA)、糖类抗原125(CA125)等6种肺癌肿瘤标志物(tumor Markers,TM)检测对高危人群早期肺癌筛查的效能。方法统计分析2015年-2019年间在本院进行LDCT检查且有病理结果的受试者以及CT结果阴性受试者相关数据,对比分析CT、血清TM的水平以及CT征象及血清TM联合检测对肺癌的诊断价值。结果CT检出肺癌的敏感性为81.48%,特异度为50.00%;TM检出肺癌的敏感性为66.67%,特异度为66.67%;CT联合TM对肺癌的灵敏度为62.96%,漏诊率37.04%,特异度为100.00%。肺癌组患者TM明显高于LDCT结果阴性受试者组,而CT结果阴性受试者的TM检测结果均为阴性,两组差异有统计学意义(P<0.05),结论LDCT敏感性较高,特异度低,肿瘤标志物特异度高,LDCT与TM检测较高合理组合应用,可以优势互补,减少LDCT的假阳性率,对早期肺癌的筛查具有较大价值,可作为辅助筛查手段。而对CT结果阴性者不建议常规做TM检测。

Objective To evaluate the diagnostic efficacy of low-dose spiral computed tomography(LDCT)combined with six tumor markers(CYFRA21-1,SCC,NSE,GRP,CEA,CA 125)for early stage lung cancer in high-risk population.Methods The data of subjects with successful follow-up and pathological results and subjects with negative CT results from 2015 to 2019 were statistically analyzed.The levels of CT and serum tumor markers and the diagnostic value of combined detection of CT signs and serum tumor markers for lung cancer were compared and analyzed.Results The sensitivity and specificity of CT were 81.48%and 50.00%respectively.The sensitivity and specificity of tumor markers were 66.67%and 66.67%respectively.The sensitivity of CT combined with tumor markers was 62.96%,and the specificity was 100.00%.The tumor markers level in lung cancer group were significantly higher than those in LDCT negative subjects,while the TM test results of CT negative subjects were all negative,there was statistical significance between the two groups(P<0.05).Conclusion LDCT has higher sensitivity and lower specificity,while the specificity of tumor markers is the highest.The combination of LDCT and tumor markers of lung cancer can complement each other and have great value in the early detection of lung cancer.This will improve the false positive rate and over-diagnosis of LDCT lung cancer screening,and can be used as a first-line auxiliary screening method.TM test is not recommended for subjects with negative CT results.