全身骨显像联合CA15-3和CEA检测对乳腺癌骨转移的诊断价值  

Diagnostic value of combined whole body bone scintigraphy and serum CA15-3,CEA in breast cancer with bone metastases

作　　者：杨志[1] 杨贵生[1] 李宁[1] 廖光星 杨鸿宇[1] 王洪良[1] 肖国有[1] YANG Zhi YANG Gui-sheng LI Ning LIAO Guang-xing YANG Hong-yu WANG Hong-liang XIAO Guo-you(Department of Nuclear Medicine ,Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, P. R. China)

机构地区：[1]广西医科大学附属肿瘤医院核医学科,广西南宁530021

出　　处：《中华肿瘤防治杂志》2016年第18期1229-1233,共5页Chinese Journal of Cancer Prevention and Treatment

基　　金：广西壮族自治区卫计委课题(Z2016498);广西教育厅(KY2016LX025;2016JGB186);广西医科大学(2015XJGB23)

摘　　要：目的全身骨显像诊断骨转移特异性低,而肿瘤标志物测定有助于筛选临床有高风险骨转移的患者,联合两者有助于早期诊断骨转移瘤。本研究主要探讨全身骨显像联合糖类抗原15-3(carbohydrate antigen 15-3,CA15-3)和癌胚抗原(carcinoembryonic antigen,CEA)检测在乳腺癌骨转移中的诊断价值。方法选取广西医科大学附属肿瘤医院2013-09-01—2015-07-31收治经病理确诊的90例乳腺癌患者为研究对象,回顾性分析其全身骨显像及CA15-3和CEA检测结果。参照Soloway分级标准,分析CA15-3和CEA与骨显像结果的关系;以穿刺病理及相关影像学表现为临床诊断骨转移金标准,分析并比较单项及联合检测对骨转移的诊断效能。结果90例乳腺癌患者平均年龄(48.30±10.31)岁。病理类型分别为浸润性导管癌82例,乳腺导管内癌5例,浸润性小叶癌2例,黏液癌1例。骨转移总体发生率为62.22%(56/90),骨转移组血清CA15-3和CEA水平较非骨转移组高,均P<0.001;按Soloway分级标准,M1占21.42%(12/56),M2占35.72%(20/56),M3占42.85%(24/56)。全身骨显像分级与CA15-3和CEA水平之间存在强相关性,r值分别为0.794和0.757,均P<0.001;随着级别升高,血清CA15-3和CEA水平也升高,各级之间差异有统计学意义,均P<0.001。全身骨显像诊断乳腺癌骨转移的灵敏度、特异性和准确性分别为89.26%(50/56)、76.47%(26/34)和85.56%(77/90);CA15-3诊断骨转移的灵敏度、特异性和准确性分别为73.21%(41/56)、85.29%(29/34)和76.67%(69/90);CEA诊断骨转移的灵敏度、特异性和准确性分别为57.14%(35/56)、79.41%(27/34)和70.00%(63/90);全身骨显像联合CA15-3和CEA检测诊断骨转移的灵敏度、特异性和准确性分别为96.43%(54/56)、88.24%(30/34)和92.22%(83/90)。经ROC曲线分析,联合检查曲线下面积(area under curve,AUC)为0.944,其诊断效能明显高于其他单项检查,均P<0.05。结论 CA15-3和CEA对监测乳腺癌骨转移有一定的价值,全身骨显像联合COBJECTIVE The specificity of whole body bone scintigraphy in the diagnosis of bone metastases is low, but the tumor markers help clinical screening high-risk patients with bone metastases, the combination of the two can help early diagnosis of bone metastases. This paper mainly discussed the diagnostic value and efficiency evaluation of combined whole body bone scintigraphy and the CA15-3,CEA level in breast cancer patients with bone metastases. METHODS Ninty cases breast cancer patients confirmed by pathology or cytology from September 1st, 2013 to July 31,2015 in Affiliated Tumor Hospital of Guangxi Medical University were retrospectively studied. The results of whole body bone scintigraphy and CA15-3, CEA test results were analyzed. The relationship of CA15-3, CEA and bone scintigraphy were studied. With biopsy and imaging findings as well as clinical findings as diagnosis standard of bone metastases, compared the efficiency of single and joint inspection for the diagnosis of bone metastases. RESULTS The average age was （48.30±10.31） years of 90 cases of breast cancer. The pathologic types were infiltrating ductal carcinoma in 82 cases, breast intraductal carcinoma in 5 cases, invasive lobular carcinoma in 2 cases and mucinous carcinoma in 1 case. Totally 56 patients with bone metastases were found in 90 cases of patients with breast cancer and the bone metastasis rate was 62. 22% （56/90）. The CA15-3, CEA level in bone metastases patients were statistically higher in the group with the whole body bone scintigraphy positive than those in the group with whole body bone scintigraphy negitive （all P〈0. 001）. By Soloway grading standards, M1 accounted for 21.42 % （12/56）. M2 accounted for 35.72% （20/56）. M3 accounted for 42.85 （24/56）. There was strong correlation between the classification of whole body bone scintigraphy and CA15-3, CEA level （r value were 0. 794, 0. 757, all P〈0. 001）. M1, M2 and M3 groups of CA15-3 and CEA levels rise step by step, at all levels the differences h

关 键 词：乳腺肿瘤 全身骨显像 糖类抗原15-3 癌胚抗原 骨转移 

分 类 号：R737.9[医药卫生—肿瘤]