螺旋CT和肿瘤标记物联检对肺癌分期分型的诊断与评价

Diagnosis and Evaluation of Staging and Typing of Lung Cancer with Spiral Computed Tomography (SCT)Combined with Tumor

目的 评价螺旋CT扫描和肿瘤标记物联合检测在肺癌分期分型中的价值。方法 收集 72例经病理证实的肺癌 (鳞癌 31例、腺癌 2 6例、小细胞癌 15例 )和 2 0例经临床或病理证实的肺良性病变 ,全部病例均行螺旋CT扫描和CYFRA2 1 1、CEA、NSE三项肿瘤标记物血清浓度测定。实验数据分析采用SAS统计处理软件。结果 ①三种肿瘤标记物测定的血清浓度与肿瘤的病理分类有关 ,鳞癌以CYFRA2 1 1最高为 (17.74± 14 .0 4 ) μg/ml(77.4 % ) ,腺癌以CEA最高为 (4 3.0 9± 35 .36 ) μg/ml,小细胞癌以NSE最高为 (36 .2 1± 2 3.0 7) μg/ml(P <0 .0 1)。②CT及肿瘤标记物对肺癌分型诊断的总体符合率分别为 6 2 .5 %和 5 1.4 %。联合检测的总体符合率为 77.8% ,与前两者相比 ,有统计学差异 (P <0 .0 5 ,P <0 .0 1)。③SCT在肺癌分期中的敏感性、特异性和诊断效率分别为 6 9.9%、92 .1%和 88.3%。各肿瘤标记的血清浓度随肿瘤分期的增高而升高 ,但在Ⅰ Ⅳ期的阳性检出率无显著差异。SCT和肿瘤标记物联检可提高敏感性和诊断效率 ,分别为 80 .9%和 94 .4 8% (P <0 .0 5 )。结论 SCT和肿瘤标记物联检 ,可提高肺癌检测的敏感性和准确率。有助于临床选择合理的治疗方案 。

Objective To evaluate the potential role of spiral computed tomography (SCT) scanning combined with examination of serum levels of tumor markers in assessment of staging and typing of lung cancer.Methods Seventy-two cases with lung cancer(squamous cell cancer,31 cases;adenocarcinoma, 26 cases; small cell lung cancer,15 cases)and 20 cases with benign lung diseases were pathologically and clinically confirmed. SCT scanning and serum levels of CYFRA21-1、CEA、NSE were performed to every case. The data were analyzed by SAS analysis system.Results ①The positive rates of the three tumor markers were related to the pathologic patterns of lung cancer. The highest diagnostic sensitivities were 77.4% for CYFRA21-1 in squamous cell cancer, while the highest one for CEA was 69.3% in adenocarcinoma, and 73.3% for NSE in small cell lung cancer(P<0.05).② The total tally rates of SCT or tumor markers with pathology for diagnoses were 62.5% and 51.4% respectively.However,the total tally rate of SCT combined with markers with pathology was 77.8%(P<0.05).③The sensitivity、specificity and diagnostic efficiency was 69.9%、92.1% and 88.2% respectively.The serum value of markers were increased as advancement of the stage,but the positive rate of serum markers were no striking different among stage Ⅰto Ⅳ. Sensitivity and specificity were increased once SCT combined with tumor markers(P<0.05).Conclusion The sensitivity and accuracy would be increased by SCT combined with serum tumor markers in diagnosis of lung cancer, which would increase the total accuracy diagnostic rate even in early stage of lung cancer.