18F-FDG PET/CT显像联合血清肿瘤标志物组合在孤立性肺结节诊断中的价值

摘要

Objective:To evaluate the diagnostic efficiency of 18F-FDG positron emission tomography/computed tomography (PET/CT) plus serum tumor markers for solitary pulmonary nodules.Methods:We retrospectively studied the clinical data of 95 cases with solitary pulmonary nodules (SPN).These cases underwent 18F-FDG PET/CT and serum tumor markers (CEA,SCC,CYFRA21-1,NSE) inspections within ten days prior to the operations.The sensitivity,specificity,accuracy,positive predictive value (PPV) and negative predictive value (NPV) and correlations between clinicopathologic features and standard uptake value in maximum (SUVmax) were evaluated,respectively.Results:A total of 67 patients and 28 patients were diagnosed as lung cancer and benign lung diseases,respectively.With regard to SPNs,the sensitivity,specificity,accuracy of the serum tumor markers and 18 F-FDG PET/CT were 35.8 ％,82.1％,49.5 ％ and 88.1％,85.7 ％,87.4 ％,respectively.Interestingly,the sensitivity,specificity,accuracy by using tumor markers plus 18F-FDG PET/CT were 91.0％,82.1％ and 88.4％.The sensitivity,accuracy of by using tumor markers plus 18F-FDG PET/CT or 18F-FDG PET/CT were significantly higher than sole use of serum tumor markers (P ＜ 0.05).18F-FDG PET/CT plus serum tumor markers had lower specificity,but higher sensitivity and accuracy,compared with 18F-FDG PET/CT alone.Conclusion:The combined use of 18F-FDG PET/CT and serum tumor markers is contributive to the diagnosis of SPN.%目的:评价18F-FDG PET/CT显像联合血清肿瘤标志物检测在孤立性肺结节诊断中的价值.方法:总结2012年7月至2015年7月间的95例孤立性肺结节(SPN)病例,所有结节均行18F-FDG PET/CT扫描及肺癌肿瘤标志物四项组合[癌胚抗原(CEA)、神经元特异性烯醇化酶(NSE)、鳞状上皮细胞癌抗原(Scc)、细胞角蛋白19片段抗原21-1(CYFRA21-1)]检测,所有检测在10天内完成,分别计算18F-FDG PET/CT显像、肺癌肿瘤标志物四项组合、18F-FDG PET/CT联合肺癌肿瘤标志物四项组合3种方法的灵敏性、特异性、精确度、PPV、NPV,并分析病理类型对糖代谢的影响及相互之间的关系.结果:在95例病例中,67例确诊为肺癌,28例为良性病变.单项18F-FDG PET/CT检查的灵敏性、特异性、精确度分别为88.1％、85.7％、87.4％,肺癌肿瘤标志物四项组合诊断分别为35.8％、82.1％和49.5％,联合诊断分别为91.0％、82.1％和88.4％.联合诊断、单项18F-FDG PET/CT诊断SPN灵敏性、精确度显著高于单项肺癌肿瘤标志物四项组合检测(P＜0.05),而联合诊断与单独18F-FDG PET/CT诊断相比,特异性低,而灵敏性、精确度高于18F-FDGPET/CT.结论:与单纯肺癌肿瘤标志物四项组合比较,单纯18F-FDG PET/CT显像、联合诊断对SPN诊断价值明显优于前者,肺癌肿瘤标志物四项组合可以作为18F-FDG PET/CT对SPN诊断及鉴别诊断的补充,可为无法获得病理结果的患者提供理想的诊断手段.