增强CT联合血清CYFER21-1、NSE诊断NSCLC患者发生淋巴结转移的价值  

The value of enhanced CT combined with serum CYFER21-1 and NSE in the diagnosis of lymph node metastasis in patients with NSCLC

作　　者：张树茂 张冉冉 李强[3] 王立兵 Zhang Shumao;Zhang Ranran;Li Qiang;Wang Libing(Department of Nuclear Medicine,Linyi Tumour Hospital,Linyi 276000,China;Department of Imaging,Linyi Tumour Hospital,Linyi 276000,China;Department of Imaging,Linyi Traditional Chinese Medical Hospital,Linyi 276000,China)

机构地区：[1]临沂市肿瘤医院核医学科,临沂276000 [2]临沂市肿瘤医院影像科,临沂276000 [3]临沂市中医医院影像科,临沂276000

出　　处：《中国医师杂志》2023年第3期416-420,共5页Journal of Chinese Physician

摘　　要：目的探讨术前增强CT联合血清细胞角片段19(CYFER21-1)、神经元特异性烯醇化酶(NSE)诊断非小细胞肺癌(NSCLC)患者发生淋巴结转移的价值。方法回顾性选取临沂市肿瘤医院2018年10月至2021年10月收治的160例NSCLC患者,所有患者均在本院接受手术治疗,术后证实84例患者发生淋巴结转移(转移组)、76例患者未发生淋巴结转移(非转移组),对比两组患者手术前的增强CT图像特征及血清CYFER21-1、NSE水平,并采用受试者工作特征(ROC)曲线分析各项指标单独及联合应用诊断NSCLC患者发生淋巴结转移的价值。结果转移组患者中病灶长径≥3.0 cm、胸膜凹陷、CT显示淋巴结肿大、淋巴结短径≥10 mm、淋巴结边界模糊、淋巴结强化的患者占比均显著大于非转移组患者,差异均有统计学意义(均P<0.05);转移组患者的血清CYFER21-1、NSE水平显著高于非转移组,差异均有统计学意义(均P<0.05);CYFER21-1、NSE水平诊断NSCLC患者发生淋巴结转移的AUC值分别为0.652、0.845,诊断截断值分别为4.81 ng/ml、24.14 ng/ml;CYFER21-1+NSE+增强CT诊断NSCLC患者发生淋巴结转移的灵敏度为91.67%,特异度为94.74%。结论术前增强CT诊断NSCLC患者发生淋巴结转移具有一定的临床价值,结合血清CYFER21-1、NSE水平能进一步提高诊断的灵敏度和特异度。Objective To investigate the value of preoperative enhanced CT combined with serum cytokeratin fragment 19(CYFER21-1)and neuron-specific enolase(NSE)in the diagnosis of lymph node metastasis in patients with non-small cell lung cancer(NSCLC).Methods 160 patients with NSCLC admitted to Linyi Cancer Hospital from October 2018 to October 2021 were retrospectively selected.All patients received surgical treatment in our hospital,and 84 patients with lymph node metastasis(metastatic group)and 76 patients without lymph node metastasis(non-metastatic group)were confirmed after surgery.The features of enhanced CT images and serum CYFER21-1 and NSE levels were compared between the two groups before operation,and the value of each index in the diagnosis of lymph node metastasis in patients with NSCLC alone and in combination was analyzed by receiver operating characteristic(ROC)curve.Results The proportions of patients with lesion diameter≥3.0 cm,pleural depression,lymph node enlargement shown by CT,lymph node short diameter≥10 mm,lymph node boundary ambiguity and lymph node enhancement in metastatic group were significantly higher than those in non-metastatic group,with statistical significance(all P<0.05).Serum CYFER21-1 and NSE levels in metastatic group were significantly higher than those in non-metastatic group,with statistical significance(all P<0.05).The area under curve(AUC)of CYFER21-1 and NSE levels in the diagnosis of lymph node metastasis in NSCLC patients were 0.652 and 0.845,respectively,and the diagnostic cut-off values were 4.81 ng/ml and 24.14 ng/ml,respectively.The sensitivity and specificity of CYFER21-1+NSE+enhanced CT in the diagnosis of lymph node metastasis in NSCLC patients were 91.67%and 94.74%.Conclusions Preoperative enhanced CT is of certain clinical value in the diagnosis of lymph node metastasis in NSCLC patients.Combined with serum CYFER21-1 and NSE levels,enhanced CT can further improve the sensitivity and specificity of diagnosis.

关 键 词：癌 非小细胞肺 淋巴转移 体层摄影术 X线计算机 角蛋白19 神经元特异性烯醇化酶 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]