Diagnostic value of high-resolution CT combined with detection of lung cancer serum tumor markers in early lung cancer
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摘要:
目的探究高分辨率CT（HRCT）联合血清肿瘤标志物检测对早期肺癌的诊断价值。 方法选取2016年3月~2019年11月本院80例早期肺癌患者作为肺癌组，同期选取80例肺良性病变者作为良性组。所有患者均进行HRCT检查及肺癌血清标志物（癌胚抗原、CA125、神经元特异性烯醇化酶、细胞角蛋白19片段）检测，比较两组HRCT影像结果及血清标志物水平，以病理结果为金标准，分析HRCT、血清标志物及二者联合检查的诊断效能。 结果肺癌组与良性组影像特征中分叶征、毛刺征、界面、囊状透亮影比较差异有统计学意义（P < 0.05），肺癌组血清癌胚抗原、CA125、神经元特异性烯醇化酶、细胞角蛋白19片段水平均高于良性组（P < 0.05）。以病理结果为金标准，HRCT单独诊断肺癌灵敏度、特异度、准确度分别为75.00%、92.50%、83.75%，血清标志物分别为85.00%、78.75%、81.75%，二者联合分别为96.25%、77.50%、86.87%；HRCT、血清肿瘤标志物及联合检测诊断早期肺癌的受试者工作特征曲线下面积分别为0.838、0.819、0.875（P < 0.001）。 结论HRCT与肺癌血清标志物对早期肺癌均有一定诊断价值，且二者联合检查能进一步提高诊断灵敏度及准确度，值得临床应用。 Abstract:ObjectiveTo explore the diagnostic value of high-resolution CT (HRCT) combined with detection of serum tumor markers on early lung cancer. MethodsFrom March 2016 to November 2019, 80 patients with early lung cancer and 80 patients with benign lung lesions in the hospital were selected. HRCT examination and detection of lung cancer serum markers [carcinoembryonic antigen (CEA), carbohydrate antigen CA 125, neuron-specific enolase (NSE), cytokeratin 19 fragment (CYFRA21-1)] were performed on all patients. The HRCT imaging results and serum markers levels were compared between the two groups. The pathological results were taken as the gold standards to analyze the diagnostic efficacy of HRCT, serum markers and the combination of the two. ResultsThe differences of the imaging features of lobulation sign, spicule sign, interfaces and cystic lucency shadow between lung cancer group and benign group were significant (P < 0.05). The levels of serum CEA, CA125, NSE and CYFRA21-1 in lung cancer group were significantly higher than those in benign group (P < 0.05). With the pathological results as the gold standards, the sensitivity, specificity and accuracy of HRCT in the diagnosis of lung cancer were75.00%, 92.50% and 83.75%, the above indexes of serum markers were 85.00%, 78.75% and 81.75% respectively, and above indexes of the combination of the two were 96.25%, 77.50% and 86.87%. The values of area under the receiver operating characteristic curve (ROC curve) of HRCT, serum tumor markers and combined detection of early lung cancer were 0.838, 0.819 and 0.875(P < 0.001). ConclusionHRCT and lung cancer serum markers have certain diagnostic value on early lung cancer. The combined examination of the two can further improve the diagnostic sensitivity and accuracy. -
Key words:
- early lung cancer /
- high-resolution CT /
- serum tumor markers /
- diagnosis /
- ROC curve
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图 1 肺癌患者典型CT影像特征图片
A:女, 47岁, 右肺上叶前段见2.5 cm左右占位, 形状不规则; B:男, 65岁, 右上肺门、肺叶肿块, 周围可见毛刺征; C：女, 72岁, 右上肺叶占位, 形状不规则, 病灶与周围不张肺组织、右上肺动脉、静脉分界不清; D:男, 61岁, 右肺下叶外侧基底段0.3 cm小结节, 可见空泡征.
Figure 1. Typical CT imaging features of lung cancer patients.
图 2 HRCT、血清肿瘤标志物及联合检测诊断早期肺癌的ROC曲线
Figure 2. ROC curves of HRCT, serum tumor markers and combined detection in the diagnosis of early lung cancer
表 1 肺癌组与良性组HRCT影像特征比较
Table 1. Comparison of HRCT imaging features between lung cancer group and benign group[n=80, n(%)]
影像特征 肺癌组 良性组 t/χ2 P 病灶直径(cm, Mean±SD) 2.25±0.78 2.11±0.54 1.320 0.189 分叶征 51.601 0.000 有 57 (71.25) 12(15.00) 无 23(28.75) 68(85.00) 毛刺征 29.565 0.000 有 51(63.75) 17(21.25) 无 29(36.25) 63(78.75) 形状 3.750 0.053 不规则形 54(67.50) 42(52.50) 圆形或类圆形 26(32.50) 38(47.50) 界面 32.918 0.000 模糊 17(21.25) 49(61.25) 清楚光整 22(27.50) 20(25.00) 清楚毛糙 41(51.25) 11(13.75) 空泡征 1.290 0.256 有 21(26.25) 15(18.75) 无 59(73.75) 65(81.25) 支气管征 3.620 0.057 有 49(61.25) 37(46.25) 无 31(38.75) 43(53.75) 囊状透亮影 17.348 0.000 有 29(36.25) 7(8.75) 无 51(63.75) 73(91.25) 胸膜凹陷征 3.025 0.082 有 46(57.50) 35(43.75) 无 34(42.50) 45(56.25) 血管集束征 2.525 0.112 有 41(51.25) 31(38.75) 无 39(48.75) 49(61.25) 
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表 2 肺癌组与良性组血清标志物水平比较
Table 2. Comparison of serum markers levels between lung cancer group and benign group (n=80, Mean±SD)
组别 肺癌组 良性组 t P CEA (ng/mL) 17.41±5.02 3.05±0.73 25.319 0.000 CA125 (U/mL) 48.82±12.21 12.15±3.69 25.714 0.000 NSE (ng/mL) 20.62±5.13 10.47±3.96 14.009 0.000 CYFRA21-1 (ng/mL) 7.28±2.51 2.25±0.75 17.276 0.000
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表 3 HRCT、血清肿瘤标志物的诊断效能
Table 3. Diagnostic efficacy of HRCT and serum tumor markers (n=80)
病理结果 HRCT 血清标志物 二者联合 恶性 良性 恶性 良性 恶性 良性 恶性 60 20 68 12 77 3 良性 6 74 17 63 18 62
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表 4 HRCT、血清肿瘤标志物及联合检测的ROC曲线
Table 4. ROC curves of HRCT, serum tumor markers and combined detection
指标 AUC 标准误 P 95%CI 上限 下限 HRCT 0.838 0.034 0.000 0.771 0.904 血清标志物 0.819 0.035 0.000 0.750 0.888 二者联合 0.875 0.030 0.000 0.816 0.934
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