肿瘤标志物CEA/CYFRA21-1比值联合液基细胞学对非小细胞肺癌分型的诊断价值  

The Value of Serum CEA/CYFRA21-1 Ratio Combined with Brush Liquid Based Cytology in the Classification and Diagnosis of Non-small Cell Lung Cancer

作　　者：鞠惠 朱立强 赵利[3] JU Hui;ZHU Liqiang;ZHAO Li(Department of Clinical Laboratory,the General Hospital of Xuzhou Mining Bureau,Xuzhou City,Jiangsu Province 221006;不详)

机构地区：[1]徐州矿务集团总医院检验科,江苏省徐州市221006 [2]徐州医科大学附属医院检验科 [3]徐州市肿瘤医院检验科

出　　处：《医学理论与实践》2020年第23期3880-3882,3888,共4页The Journal of Medical Theory and Practice

摘　　要：目的:探讨血清肿瘤标志物癌胚抗原(Carcinombryonic antigen,CEA)、细胞角蛋白19片段(Cytokerantin 19 fragment,CYFRA21-1)的比值(CEA/CYFRA21-1)联合纤维支气管镜液基细胞学对非小细胞肺癌(Non-small cell lung cancer,NSCLC)分型的诊断价值。方法:收集纤支镜刷检细胞学诊断为非小细胞肺癌的病例62例,根据细胞形态进行分型。应用化学免疫技术分别检测患者血清中的CEA、CYFRA21-1含量水平,并计算CEA/CYFRA21-1比值。利用ROC曲线计算CEA/CYFRA21-1比值在鉴别诊断非小细胞肺癌的最佳界值。结果:以组织病理学为金标准,62例病例均为非小细胞肺癌,其中鳞癌26例、腺癌36例。肺鳞癌组CYFRA21-1水平[7.74(5.55,19.93)]ng/ml与肺腺癌组[8.56(4.66,16.45)]ng/ml比较,差异无统计学意义(Z=-0.658,P=0.493);肺鳞癌组CEA水平[3.8(2.96,6.62)]ng/ml低于肺腺癌组[16.90(12.00,44.07)]ng/ml,差异具有统计学意义(Z=-5.538,P<0.001)。CEA/CYFRA21-1值在鉴别鳞癌和腺癌的ROC曲线下面积为0.944,敏感度为83.3%、特异度为92.3%、最佳判断值为1.03。与组织病理学对比,细胞学准确分型40例,其中鳞癌18例、腺癌22例,均与组织病理学相符,但有22例由于肿瘤分化差,分型诊断不明。如以CEA/CYFRA21-1>1.03为诊断肺腺癌的临界值的原则,22例细胞学分类不明的病例,被2种方法联合诊断鳞癌13例,腺癌9例,其中3例腺癌被误诊为鳞癌,鳞癌病例全部相符。结论:CEA/CYFRA21-1比值可辅助细胞学区分非小细胞肺癌的病理类型,有助于非小细胞肺癌的鉴别诊断。Objective:To evaluate the value of serum CEA/CYFRA21-1 ratio combined with brush liquid based cytology in the classification and diagnosis of non-small cell lung cancer(NSCLC).Methods:62 cases with NSCLC were diagnosed by brush liquid based cytology(LCT),including 26 cases with lung squamous carcinoma and 36 cases with lung adenocarcinoma.The levels of serum tumor markers(CEA and CYFRA21-1)were detected by chemiluminescence immunoassay and calculate the ratio of CEA/CYFRA21-1.ROC curve was used to evaluate the best value of CEA/CYFRA21-1 ratio in the differential diagnosis of NSCLC.Results:There was no significant difference in CYFRA21-1 level between lung squamous cell carcinoma group[7.74(5.55,19.93)]ng/ml and lung adenocarcinoma group[8.56(4.66,16.45)]ng/ml(Z=-0.658,P=0.493).CEA level in the lung squamous cell carcinoma group[3.8(2.96,6.62)]ng/ml was lower than lung adenocarcinoma group[16.90(12.00,44.07)]ng/ml,and the difference was statistically significant(Z=-5.538,P<0.001).At the threshold of 1.03,sensitivity and specificity of CEA/CYFRA21-1 as a serologic marker were 83.3%and 92.3%,respectively for distinguish lung squamous carcinoma and lung adenocarcinoma.ROC curve showed that the under-curve area(AUC)was 0.944.Compared with histopathology,cytology was accurately classified in 40 cases,including squamous cell carcinoma in 18 cases and adenocarcinoma in 22 cases,all of which were consistent with histopathology.However,due to poor tumor differentiation,classification was unknown in 22 cases.If CEA/CYFRA21-1>1.03 was taken as the threshold value for the diagnosis of lung adenocarcinoma.Among the 22 cases with unknown cytological classification,13 cases of squamous cell carcinoma and 9 cases of adenocarcinoma were diagnosed by two combined methods,among which 3 cases of adenocarcinoma were misdiagnosed as squamous cell carcinoma,and all the cases of squamous cell carcinoma were consistent.Conclusion:Combined examination of CEA/CYFRA21-1 ratio and brush liquid based cytology can effectively improve the accur

关 键 词：非小细胞肺癌 分型 CEA/CYFRA21-1 比值 肿瘤标志物 液基细胞学 

分 类 号：R734.2[医药卫生—肿瘤]