鳞状细胞癌抗原检测联合磁共振成像对判断早期宫颈癌盆腔淋巴结转移的临床意义

Clinical significance of squamous cell carcinoma antigen combined with magnetic resonance imaging in diagnosing pelvic lymph node metastasis of early cervical cancer

背景与目的:宫颈癌是否发生淋巴结转移不仅决定着预后,还指导着术后辅助治疗;因此对淋巴结转移进行相关研究具有重要的意义。本文皆在分析宫颈癌发生盆腔淋巴结转移的相关因素,探讨鳞状细胞癌抗原(squamous cell carcinoma antigen,SCCAg)检测联合磁共振成像(magnetic resonance imaging,MRI)对宫颈癌盆腔淋巴结转移的临床应用价值。方法:回顾性分析2016年7月—2018年3月在蚌埠医学院第一附属医院治疗的ⅠA～ⅡA期110例宫颈鳞癌患者的临床相关资料;采用SPSS 22.0软件进行相关统计学分析。结果:SCCAg检测判断宫颈癌盆腔淋巴结转移的受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积为0.695,最佳临界值为2.45 ng/mL,95%CI为0.577～0.812,其阳性预测值为46%,阴性预测值为84%,准确率为71%,灵敏度为58.6%,特异度为75.3%(Kappa值=0.312,P=0.001);术前MRI检查诊断宫颈鳞癌盆腔淋巴结转移的阳性预测值为77%,阴性预测值为89%,准确率为86.4%,灵敏度为69.0%,特异度为92.6%(Kappa值=0.637,P=0.000);两者联合诊断宫颈鳞癌盆腔淋巴结转移的阳性预测值为55%,阴性预测值为97%,准确率为78.1%,灵敏度为93.1%,特异度为72.8%(Kappa值=0.540,P=0.000);单因素分析显示,淋巴结转移与SCCAg>2.45ng/mL、间质浸润深度、切缘浸润及脉管浸润有关;多因素分析显示,间质浸润及脉管浸润是盆腔淋巴结转移的独立危险因素。结论:宫颈癌盆腔淋巴结转移与SCCAg>2.45 ng/mL、间质浸润深度、切缘浸润及脉管浸润相关,尤其当有间质浸润及脉管浸润时,淋巴结转移的可能性更不可忽视;而在诊断淋巴结转移方面,MRI要优于SCCAg检查,当两者结合可显著提高其灵敏度及阴性预测值,对宫颈癌无盆腔淋巴结转移的判断具有重要的临床意义。

Background and purpose: Lymph node metastasis of cervical cancer not only determines the prognosis, but also guides postoperative adjuvant therapy, and therefore it is of great significance to study the lymph node metastasis. This article aimed to evaluate the clinical value of squamous cell carcinoma antigen(SCCAg) combined with magnetic resonance imaging(MRI) in the diagnosis of pelvic lymph node metastasis of cervical squamous cell carcinoma. Methods: The clinical data of 110 patients with stage ⅠA-ⅡA cervical squamous cell carcinoma treated in our hospital from Jul. 2016 to Mar. 2018 were retrospectively analyzed.Statistical analysis was performed using SPSS 22.0 software. Results: The area under the receiver operating characteristic(ROC)curve of SCCAg to determine pelvic lymph node metastasis of cervical cancer in subjects was 0.695. The best critical value was2.45 ng/mL, and 95%CI was 0.577-0.812. The positive predictive value was 46%,and the negative predictive value was 84%. The diagnostic accuracy was 71%,the sensitivity was 58.6%, and the specificity was 75.3%(Kappa=0.312, P=0.001). The positive predictive value of preoperative MRI in the diagnosis of pelvic lymph node metastasis in cervical squamous cell carcinoma was77%. The negative predictive value was 89%. The accuracy rate was 86.4%.The sensitivity was 69.0%. The specificity was 92.60%(kappa=0.637, P=0.000). The positive predictive value of the combined diagnosis of pelvic lymph node metastasis of cervical squamous cell carcinoma was 55%, the negative predictive value was 97%, the accuracy was 78.1%, the sensitivity was 93.1%, and the specificity was 72.8%(Kappa=0.540, P=0.000). In univariate analysis, lymph node metastasis was associated with SCCAg>2.45 ng/mL, depth of interstitial infiltration, incision margin infiltration and vascular infiltration. Multivariate analysis showed that interstitial infiltration and vascular infiltration were independent risk factors for pelvic lymph node metastasis. Conclusion: Pelvic lymph node metastasis is associated with SCCAg>2.45 ng/mL, depth of interstitial invasion, incision margin infiltration and vascular infiltration. Especially when the interstitial infiltration and vascular infiltration are present, the possibility of lymph node metastasis could not be ignored. For the diagnosis of lymph node metastasis, MRI is superior to SCCAg. When SCCAg is combined with MRI,the sensitivity and negative predictive value can be significantly improved, which has important clinical significance for the diagnosis of cervical cancer without pelvic lymph node metastasis.