Application of 256-slice spiral CT combined with serum CEA, CYFRA21-1 and ProGRP in the diagnosis of primary lung cancer
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摘要:
目的 探究256排螺旋CT联合血清癌胚抗原(CEA)、细胞角蛋白19片段(CYFRA21-1)、胃泌素释放肽前体(ProGRP)在诊断原发性肺癌中的应用价值。 方法 回顾性分析2020年1月~2022年4月收治的181例原发性肺癌患者临床资料,患者均已接受256排MSCT检查及血清肿瘤标志物CEA、CYFRA21-1、ProGRP检查,分析影像学表现及血清学检查结果,并以病理学诊断结果为金标准,判定各项指标对原发性肺癌的诊断正确率。 结果 病理组织学检查:181例原发性肺癌患者中腺癌91例,鳞癌61例,小细胞癌29例。CT影像学特征:腺癌以周围型为主,多见磨玻璃影、血管集束征、分叶状、毛刺样改变、强化不均匀、胸膜凹陷;鳞癌、小细胞癌均以中央型为主,鳞癌多见支气管充气征、空泡征、分叶状、强化均匀,小细胞癌多见支气管充气征、空泡征、强化均匀,鳞癌分叶状征象占比多于小细胞癌(P < 0.05),小细胞癌强化均匀占比多于鳞癌(P < 0.05);各类型肺癌均伴有少量钙化;腺癌者、鳞癌者CEA、CYFRA21-1水平均高于小细胞癌者,ProGRP水平均显著低于小细胞癌者,腺癌者CEA水平高于鳞癌者,腺癌者MSCT、CEA检测阳性率高于CYFRA21-1、ProGRP,鳞癌者MSCT、CYFRA21-1检测阳性率高于CEA、ProGRP,小细胞癌者MSCT、ProGRP检测阳性率高于CEA、CYFRA21-1,差异有统计学意义(P < 0.05)。4项联合检测对腺癌、鳞癌、小细胞癌3类的检测阳性率均提高。 结论 256排MSCT诊断原发性肺癌可清晰显示病变CT影像学特征,与血清肿瘤标志物CEA、CYFRA21-1、ProGRP均可较好诊断不同病理类型的原发性肺癌,且四项联合诊断可提高阳性检出率。 Abstract:Objective To explore the application value of 256-slice spiral CT combined with serum carcinoembryonic antigen (CEA), cytokeratin 19 fragment (CYFRA21-1) and precursor gastrin-releasing peptide (ProGRP) in the diagnosis of primary lung cancer. Methods Clinical data of 181 patients with primary lung cancer who were admitted from January 2020 to April 2022 were retrospectively analyzed. All the patients received 256-slice MSCT examination and detection of serum tumor markers CEA, CYFRA21-1 and ProGRP. The imaging findings and serological examination results were analyzed.The pathological diagnosis results were used as the gold standard to determine the diagnostic accuracy rate of each indicator on primary lung cancer. Results Histopathological examination showed that among the 181 patients with primary lung cancer. There were 91 cases of adenocarcinoma, 61 cases of squamous cell carcinoma and 29 cases of small cell carcinoma. CT imaging features were shown that adenocarcinoma was mainly with peripheral type, more ground glass shadow, vessel convergence sign, lobulation, spiculated changes, uneven enhancement and pleural indentation. The squamous cell carcinoma and small cell carcinoma were with mainly central type. Squamous cell carcinoma was mainly characterized by air bronchogram, vacuole sign, lobulation and even enhancement while small cell carcinoma was mainly characterized by air bronchogram, vacuole sign and even enhancement. The proportion of lobulation sign of squamous cell carcinoma was higher than small cell carcinoma (P < 0.05). The proportion of even enhancement of small cell carcinoma was higher than squamous cell carcinoma (P < 0.05). All types of lung cancer were accompanied by a small amount of calcification. The levels of CEA and CYFRA21-1 in patients with adenocarcinoma or squamous cell carcinoma were higher than those in patients with small cell carcinoma while the ProGRP level was significantly lower than that in patients with small cell carcinoma. The CEA level in patients with adenocarcinoma was significantly higher than that in patients with squamous cell carcinoma. The positive detection rate of MSCT or CEA in patients with adenocarcinoma was higher than CYFRA21-1 and ProGRP, the positive detection rate of MSCT or CYFRA21-1 in patients with squamous cell carcinoma was higher than CEA and ProGRP. The positive detection rate of MSCT or ProGRP in patients with small cell carcinoma was higher than CEA and CYFRA21-1 (P < 0.05). The positive detection rates of adenocarcinoma, squamous cell carcinoma and small cell carcinoma were all enhanced in the combined detection of the four indicators. Conclusion 256-slice MSCT in the diagnosis of primary lung cancer can clearly display the CT imaging features of lesions. Serum tumor markers CEA, CYFRA21-1 and ProGRP can better diagnose primary lung cancer with different pathological types, and the combined diagnosis of the four can improve the positive detection rate. -
Key words:
- primary lung cancer /
- 256-slice spiral CT /
- CEA /
- CYFRA21-1 /
- ProGRP /
- diagnostic value
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表 1 256排MSCT原发性肺癌影像学表现
Table 1. Imaging findings of primary lung cancer with 256-slice MSCT [n(%)]
表现 腺癌(n=91) 鳞癌(n=61) 小细胞癌(n=29) 分型 中央型 29(31.87) 38(62.30)a 24(82.76)a 周围型 62(68.13) 23(37.70) 5(17.24) 内部结构 磨玻璃影 57(62.64) 21(34.43)a 10(34.48)a 支气管充气征 19(20.88) 46(75.41)a 24(82.76)a 空泡征 19(20.88) 46(75.41)a 24(82.76)a 钙化 14(15.38) 10(16.39) 7(24.14) 空洞 6(6.59) 3(4.92) 2(6.90) 血管集束征 46(50.55) 13(21.31)a 3(10.34)a 边缘特征 分叶状 69(75.82) 37(60.66)a 11(37.93)ab 毛刺样改变 78(75.71) 20(32.79)a 10(34.48)a 刺突征 44(48.35) 13(21.31)a 11(37.93) 强化方式 均匀 14(15.38) 34(55.74)a 25(86.21)ab 邻近结构 胸膜凹陷 57(62.64) 13(21.31)a 6(20.69)a aP < 0.05 vs腺癌; bP < 0.05 vs鳞癌. 表 2 不同病理类型原发性肺癌的血清肿瘤标志物水平比较
Table 2. Comparison of levels of serum tumor markers among different pathological types of primary lung cancer
病理诊断 腺癌(n=91) 鳞癌(n=61) 小细胞癌(n=29) CEA(ng/mL) 8.76(3.76, 41.48) 5.41(2.97, 8.64)a 3.65(2.52, 7.72)ab CYFRA21-1(ng/mL) 5.42(3.58, 11.81) 6.62(4.34, 12.97) 3.48(2.28, 7.53)ab ProGRP(pg/mL) 46.87(35.17, 61.25) 47.29(34.61, 64.32) 142.21(45.82, 1063.37)ab aP < 0.05 vs腺癌; bP < 0.05 vs鳞癌. CEA: 癌胚抗原; CYFRA21-1: 细胞角蛋白19片段; ProGRP: 胃泌素释放肽前体. 表 3 256排MSCT、血清肿瘤标志物对不同病理类型原发性肺癌检测阳性率
Table 3. Positive rates of 256-slice MSCT and serum tumor markers for primary lung cancer of different pathological types [n(%)]
病理诊断 腺癌(n=91) 鳞癌(n=61) 小细胞癌(n=29) CEA 71(78.02) 29(47.54) 5(17.24) CYFRA21-1 58(63.74)a 52(85.25)a 13(44.83)a ProGRP 11(12.09)ab 9(14.75)ab 25(86.21)ab MSCT 80(87.91)bc 55(90.16)ac 25(86.21)ab 四项联合 85(93.41)abcd 58(95.08)ac 27(93.10)ab aP < 0.05 vs同病理类型中CEA; bP < 0.05 vs同病理类型中CYFRA21-1; cP < 0.05 vs同病理类型中ProGRP; dP < 0.05 vs同病理类型中MSCT. -
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