[1]陈鹏,宋长祥,陆武,等.SPECT同机定位CT引导经皮肺穿刺活检术联合肿瘤标志物检测对周围型肺癌的诊断价值[J].国际放射医学核医学杂志,2018,(1):21-24,29.[doi:10.3760/cma.j.issn.1673-4114.2018.01.004]
 Chen Peng,Song Changxiang,Lu Wu,et al.Diagnostic value of lung biopsy through SPECT with CT-guided percutaneous paracentesis and tumor markers for peripheral lung cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2018,(1):21-24,29.[doi:10.3760/cma.j.issn.1673-4114.2018.01.004]
点击复制

SPECT同机定位CT引导经皮肺穿刺活检术联合肿瘤标志物检测对周围型肺癌的诊断价值(/HTML)
分享到:

《国际放射医学核医学杂志》[ISSN:1673-4114/CN:12-1381/R]

卷:
期数:
2018年第1期
页码:
21-24,29
栏目:
临床研究
出版日期:
2018-03-20

文章信息/Info

Title:
Diagnostic value of lung biopsy through SPECT with CT-guided percutaneous paracentesis and tumor markers for peripheral lung cancer
作者:
陈鹏 宋长祥 陆武 刘永 袁小帅 杜鹏
222002, 徐州医科大学附属连云港医院, 连云港第一人民医院核医学科
Author(s):
Chen Peng Song Changxiang Lu Wu Liu Yong Yuan Xiaoshuai Du Peng
Department of Nuclear Medicine, the First People’s Hospital of Lianyungang, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222002, China
关键词:
体层摄影术发射型计算机单光子体层摄影术X线计算机肺肿瘤穿刺活检术肿瘤标志物
Keywords:
Tomographyemission-computedsingle-phtonTomographyX-ray computedLung carcinomaBiopsyTumor markers
DOI:
10.3760/cma.j.issn.1673-4114.2018.01.004
摘要:
目的 探讨SPECT的同机定位CT引导经皮肺穿刺活检术联合肿瘤标志物检测对周围型肺癌的诊断价值。方法 回顾性分析275例周围型肺占位患者,均行SPECT同机定位CT引导下肺穿刺活检术,取材样本长1.0~1.5 cm,并结合肿瘤标志物检测,评价其在周围型肺癌诊断中的价值。采用SPSS13.0软件进行统计学分析,组间比较采用t检验或是近似t检验。结果 275例经皮肺穿刺活检术均穿刺成功,穿刺成功率为100%。肺穿刺活检诊断周围型肺癌的灵敏度、特异度、准确率分别为97.01%、100%、97.82%。非小细胞肺癌(NSCLC)与小细胞肺癌(SCLC)的血清癌胚抗原、细胞角蛋白19片段21-1值之间的差异无统计学意义(t=1.081、0.666,均P > 0.05),SCLC的神经元特异烯醇化酶(NSE)值高于NSCLC,差异有统计学意义(t=3.671,P < 0.05);NSE值受试者工作特征曲线下面积为0.935,最佳诊断界值点为26.86 ng/mL,取26.86 ng/mL作为阈值鉴别SCLC与NSCLC所得的灵敏度、特异度分别为91.34%、84.92%。结论 SPECT同机定位CT引导下经皮肺穿刺活检术是可行的,对周围型肺癌具有较高的诊断准确率,NSE值有助于鉴别SCLC和NSCLC。
Abstract:
Objective To explore the diagnostic value of SPECT localization and CT-guided percutaneous lung biopsy and tumor markers in peripheral lung cancer. Methods A total of 275 patients with peripheral lung neoplasms were retrospectively analyzed. Pathological diagnosis was performed by SPECT with localizable CT-guided lung biopsy. The value of this imaging modality in combination with tumor markers in diagnosing lung cancer was evaluated. T-test or approximate t-test were used for data analysis using SPSS13.0 software. Results All of the lung biopsies were successful. The sensitivity, specificity, and accuracy for lung cancer diagnosis were 97.01%, 100%, and 97.82%, respectively. No significant difference in carcino-embryonic antigen and CYFRA21-1 values was detected between non-small-cell lung cancer and small-cell lung cancer(t=1.081, 0.666, both P>0.05). However, the neuron-specific enolase(NSE) value of small-cell lung cancer(SCLC) was significantly higher than that of non-small-cell lung cancer(NSCLC), and the difference was statistically significant(t=3.671, P<0.05). The area under the receiver operating curve of NSE was 0.935. The cut-off value of the diagnostic critical of NSE was 26.86 ng/mL, with a sensitivity of 91.34% and specificity of 84.92%. Conclusions SPECT with localizable CT-guided percutaneous lung biopsy is feasible and highly accurate for diagnosis of peripheral lung cancer. In addition, NSE is useful in the identification of SCLC and NSCLC.

参考文献/References:

[1] 万书友, 侯明杰, 马丽. CT引导下肺部肿块穿刺技术的临床应用[J].中国社区医师, 2014, 30(4):93, 95. DOI:10.3969/j.issn.1007-614x.2014.4.60. Wan SY, Hou MJ, Ma L. Clinical application of CT guided lung mass puncture technique[J]. Chin Comm Doctors, 2014, 30(4):93, 95.
[2] 韦莉, 刘航, 秦志强, 等. CT引导经皮肺穿刺活检对肺周围型病变的诊断价值与安全性[J]. 微创医学, 2014, 9(1):40-42. DOI:10.11864/j.issn.1673.2014.01.13. Wei L, Liu H, Qin ZQ, et al. Diagnostic value and safety of CT-guided percutaneous puncture biopsy in diagnosis of peripheral pulmonary disease[J]. J Minimally Invasive Med, 2014, 9(1):40-42.
[3] 杨雯, 李倩, 孙文逵, 等. CT引导下经皮肺穿刺活检在老年孤立性肺结节中的应用[J]. 临床肿瘤学杂志, 2014, 19(11):1015-1018. DOI:1009-0460(2014)11-1015-04. Yang W, Li Q, Sun WK, et al. CT-guided percutaneous lung biopsy for the elderly pulmonary nodules[J]. Chin Clin Oncol, 2014, 19(11):1015-1018.
[4] 杨志英, 郑浩, 张琦, 等. 超声引导经皮肺穿刺在周围型肺部病变诊断中的价值[J]. 临床肿瘤学杂志, 2014, 19(5):449-451. DOI:1009-0460(2014)05-0449-03. Yang ZY, Zheng H, Zhang Q, et al. Clinical application of ultrasound-guided percutaneous lung biopsy in peripheral pulmonary masses[J]. Chin Clin Oncol, 2014, 19(5):449-451.
[5] Laspas F, Roussakis A, Efthimiadou R, et al. Percutaneous CT-guided fine-needle aspiration of pulmonary lesions:Results and complications in 409 patients[J]. J Med Imaging Radiat Oncol, 2008, 52(5):458-462. DOI:10.1111/j.1440-1673.2008.01990.x.
[6] Battafarano RJ, Fernandez FG, Ritter J, et al. Large cell neuroendocrine carcinoma:an aggressive form of non-small cell lung cancer[J]. J Thorac Cardiovasc Surg, 2005, 130(1):166-172. DOI:10.1016/j.jtcvs.2005.02.064.
[7] Montaudon M, Latrabe V, Pariente A, et al. Factors influencing accuracy of CT-guided percutaneous biopsies of pulmonary lesions[J]. Eur Radiol, 2004, 14(7):1234-1240. DOI:10.1007/s00330-004-2250-3.
[8] 李凤, 谢雪梅, 徐洪涛. CT引导经皮肺穿刺活检诊断效果评估和并发症原因分析[J]. 西部医学, 2015, 27(10):1572-1574. DOI:10.3969/j.issn.1672-3551.2015.10.039. Li F, Xie XM, Xu HT. Diagnostic efficiency of CT-guided percutaneous for lung biopsies[J]. Med J West China, 2015,27(10):1572-1574.
[9] Yao X, Gomes MM, Tsao MS, et al. Fine-needle aspiration biopsy versus core-needle biopsy in diagnosing lung cancer:a systematic review[J]. Curr Oncol, 2012, 19(1):e16-e27. DOI:10.3747/co.19.871.
[10] Beslic S, Zukic F, Milisic S. Percutaneous transthoracic CT guided biopsies of lung lesions; fine needle aspiration biopsy versus core biopsy[J]. Radiol Oncol, 2012, 46(1):19-22. DOI:10.2478/v10019-012-0004-4.
[11] Baselga J. Why the epidermal growth factor receptor? The rationale for cancer therapy[J]. Oncologist, 2002, 7(Suppl 4):S2-8. DOI:10.1634/theoncologist.7-suppl-4-2.
[12] 高淑艳, 叶斌, 蒲高波. CT引导下经皮肺穿刺活检并发症的相关因素研究[J]. 临床肺科杂志, 2013, 18(12):2258-2259. DOI:10.3969/J.issn.1009-6636.2013.12.061. Gao SY, Ye B, Pu GB. Research of related factors of CT-guided percutaneous lung biopsy complications[J]. J Clin Pulm Med, 2013, 18(12):2258-2259.
[13] Collins LG, Haines C, Perkel R, et al. Lung cancer:diagnosis and management[J]. Am Fam Physician, 2007, 75(1):56-63.
[14] 潘清, 陈卉, 马宇晶, 等. 影像学诊断评价中的参数法ROC曲线分析[J]. 中国医学影像技术, 2011, 27(8):1694-1697. DOI:1003-3289(2011)08-1694-04. Pan Q, Chen H, Ma YJ, et al. Parametric ROC curve analysis for the performance evaluation of radiological diagnosis[J]. Chin J Med Imaging Technol, 2011, 27(8):1694-1697.

相似文献/References:

[1]周玉祥,蓝博文,黄春榆,等.64排螺旋CT冠状动脉血管成像诊断冠状动脉-肺动脉瘘的应用价值[J].国际放射医学核医学杂志,2016,40(1):26.[doi:10.3760/cma.j.issn.1673-4114.2016.01.006]
 Zhou Yuxiang,Lan Bowen,Huang Chunyu,et al.Clinical value of coronary artery-pulmonary artery fistula revealed by 64-slice spiral CT coronary angiography[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):26.[doi:10.3760/cma.j.issn.1673-4114.2016.01.006]
[2]陈超坤,刘亮,傅飞先,等.囊性胸腺瘤和囊性畸胎瘤的影像学特征及鉴别诊断[J].国际放射医学核医学杂志,2016,40(1):31.[doi:10.3760/cma.j.issn.1673-4114.2016.01.007]
 Chen Chaokun,Liu Liang,Fu Feixian,et al.Imaging features and differential diagnosis of cystic thymoma and cystic teratoma[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):31.[doi:10.3760/cma.j.issn.1673-4114.2016.01.007]
[3]岳进,苏丽萍.全身MRI与PET/CT在淋巴瘤骨髓浸润诊断及预后中的作用[J].国际放射医学核医学杂志,2016,40(1):50.[doi:10.3760/cma.j.issn.1673-4114.2016.01.010]
 Yue Jin,Su Lipin.Function of whole-body MRI and PET/CT in the diagnosis and prognosis of lymphoma with bone marrow infiltration[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):50.[doi:10.3760/cma.j.issn.1673-4114.2016.01.010]
[4]张莹莹,王振光,孔艳.PET/CT显像在肺间质纤维化中的应用进展[J].国际放射医学核医学杂志,2016,40(1):55.[doi:10.3760/cma.j.issn.1673-4114.2016.01.011]
 Zhang Yingying,Wang Zhenguang,Kong Yan.Application advancement on PET/CT in pulmonary interstitial fibrosis[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):55.[doi:10.3760/cma.j.issn.1673-4114.2016.01.011]
[5]麦卫平,张永林.能谱CT成像在肺癌诊断中的应用研究进展[J].国际放射医学核医学杂志,2016,40(1):77.[doi:10.3760/cma.j.issn.1673-4114.2016.01.015]
 Mai Weiping,Zhang Yonglin.Research progress of spectral imaging in the diagnosis of lung cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):77.[doi:10.3760/cma.j.issn.1673-4114.2016.01.015]
[6]史文杰,孟召伟,谭建.基于Deauville标准探讨18F-FDG PET/CT在霍奇金淋巴瘤复发诊断中的应用价值[J].国际放射医学核医学杂志,2016,40(2):120.[doi:10.3760/cma.j.issn.1673-4114.2016.02.007]
 Shi Wenjie,Meng Zhaowei,Tan Jian.Value of 18F-FDG PET/CT on diagnosis of Hodgkin lymphoma recurrence using Deauville criterion[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):120.[doi:10.3760/cma.j.issn.1673-4114.2016.02.007]
[7]周翠屏,廖俊杰,何国华,等.原发性肠系膜巨大淋巴结增生症的MSCT表现与病理对照分析[J].国际放射医学核医学杂志,2016,40(3):175.[doi:10.3760/cma.j.issn.1673-4114.2016.03.003]
 Zhou Cuiping,Liao Junjie,He Guohua,et al.Primary mesenteric Castleman disease:MSCT findings with histopathologic correlation[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):175.[doi:10.3760/cma.j.issn.1673-4114.2016.03.003]
[8]张巧娜,刘汉东.上颌窦上皮-肌上皮癌的CT表现一例[J].国际放射医学核医学杂志,2016,40(3):237.[doi:10.3760/cma.j.issn.1673-4114.2016.03.015]
[9]尤阳,轩昂,张杰,等.淋巴瘤患者大脑静息葡萄糖代谢改变[J].国际放射医学核医学杂志,2016,40(4):255.[doi:10.3760/cma.j.issn.1673-4114.2016.04.003]
 You Yang,Xuan Ang,Zhang Jie,et al.Changes in resting-state brain glucose metabolism in patients with lymphoma[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):255.[doi:10.3760/cma.j.issn.1673-4114.2016.04.003]
[10]王朋,崔邦平,代文莉,等.18F-FDG PET/CT在前列腺癌中的应用进展[J].国际放射医学核医学杂志,2016,40(4):277.[doi:10.3760/cma.j.issn.1673-4114.2016.04.008]
 Wang Peng,Cui Bangping,Dai Wenli,et al.Progress in the application of 18F-FDG PET/CT in prostate cancer[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):277.[doi:10.3760/cma.j.issn.1673-4114.2016.04.008]
[11]陈立,陈跃.分化型甲状腺癌骨转移诊断及疗效评价的核素显像研究进展[J].国际放射医学核医学杂志,2016,40(6):452.[doi:10.3760/cma.j.issn.1673-4114.2016.06.010]
 Chen Li,Chen Yue.Diagnosis and evaluation of curative effect progress of radionuclide imaging methods in differentiated thyroid cancer of bone metastases[J].International Journal of Radiation Medicine and Nuclear Medicine,2016,40(1):452.[doi:10.3760/cma.j.issn.1673-4114.2016.06.010]
[12]安淑娴,宋少莉,黄钢.放射性核素标记的凋亡显像剂的研究进展[J].国际放射医学核医学杂志,2015,39(6):470.[doi:10.3760/cma.j.issn.1673-4114.2015.06.008]
 An Shuxian,Song Shaoli,Huang Gang.Recent advances in apoptosis imaging using radionuclide-labeled tracers[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):470.[doi:10.3760/cma.j.issn.1673-4114.2015.06.008]
[13]陶绪长,罗晓文,关晏星.阿德福韦酯所致低血磷性骨软化症治疗前后SPECT骨显像对比一例[J].国际放射医学核医学杂志,2015,39(6):513.[doi:10.3760/cma.j.issn.1673-4114.2015.06.018]
 [J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):513.[doi:10.3760/cma.j.issn.1673-4114.2015.06.018]
[14]成钊汀,朱小华.99Tcm-MIBI显像在甲状旁腺功能亢进症中的应用及进展[J].国际放射医学核医学杂志,2015,39(1):37.[doi:10.3760/cma.j.issn.1673-4114.2015.01.009]
 Cheng Zhaoting,Zhu Xiaohua.Application and progress of 99Tcm-MIBI scintieraphy in parathyroidism[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):37.[doi:10.3760/cma.j.issn.1673-4114.2015.01.009]
[15]林潇,唐明灯.靶向表皮生长因子受体分子探针研究进展[J].国际放射医学核医学杂志,2015,39(1):85.[doi:10.3760/cma.j.issn.1673-4114.2015.01.018]
 Lin Xiao,Tang Mingdeng.Research progresses on molecular probes targeting epidermal growth factor receptor[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):85.[doi:10.3760/cma.j.issn.1673-4114.2015.01.018]
[16]刘晓梅,张芳,黄建敏.肿瘤血管生成的SPECT分子显像研究进展[J].国际放射医学核医学杂志,2015,39(2):170.[doi:10.3760/cma.j.issn.1673-4114.2015.02.015]
 Liu Xiaomei,Zhang Fang,Huang Jianmin.Research advance on molecular imaging of tumor angiogenesis with SPECT[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):170.[doi:10.3760/cma.j.issn.1673-4114.2015.02.015]
[17]刘晋华,张宝牛,赵德善.盆腔融合异位肾一例[J].国际放射医学核医学杂志,2015,39(2):190.[doi:10.3760/cma.j.issn.1673-4114.2015.02.020]
[18]陈明,刘纯,严祥,等.SPECT胃黏膜显像在胃中间横带研究中的价值[J].国际放射医学核医学杂志,2015,39(3):197.[doi:10.3760/cma.j.issn.1673-4114.2015.03.002]
 Chen Ming,Liu Chun,Yan Xiang,et al.The value of gastric mucosa SPECT in the study of midgastric transverse band[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):197.[doi:10.3760/cma.j.issn.1673-4114.2015.03.002]
[19]刘雪辉,李洪均,于鸿煦.SPECT/CT融合显像对可疑骨转移灶的诊断效能[J].国际放射医学核医学杂志,2015,39(3):201.[doi:10.3760/cma.j.issn.1673-4114.2015.03.003]
 Liu Xuehui,Li Hongjun,Yu Hongxu.Diagnostic efficacy of SPECT/CT fusion imaging in assessing possible bone metastases[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):201.[doi:10.3760/cma.j.issn.1673-4114.2015.03.003]
[20]郭宵峰,刘建中,孙琦婷.肺通气/灌注平面显像与肺灌注SPECT/CT对肺栓塞诊断价值的对比性研究[J].国际放射医学核医学杂志,2015,39(4):277.[doi:10.3760/cma.j.issn.1673-4114.2015.04.001]
 Guo Xiaofeng,Liu Jianzhong,Sun Qiting.Comparative study of pulmonary ventilation/perfusion planar imaging and pulmonary perfusion SPECT combined with low-dose CT in the diagnosis of pulmonary embolism[J].International Journal of Radiation Medicine and Nuclear Medicine,2015,39(1):277.[doi:10.3760/cma.j.issn.1673-4114.2015.04.001]

备注/Memo

备注/Memo:
收稿日期:2017-08-22。
通讯作者:陆武,Email:wangfang19820808@163.com
更新日期/Last Update: 2018-03-20