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目的探讨肿瘤标志物、肺癌概率模型在肺部结节鉴别诊断中的价值。方法纳入2013年1月至2016年1月诊治的117例肺部结节患者,根据病理结果分为肺癌组(76例)和良性病变组(41例)。分析肿瘤标志物、肺癌概率模型在肺部结节鉴别诊断中的价值。结果肺癌组癌胚抗原、糖类抗原125、神经元特异性烯醇化酶、细胞角蛋白19片段抗原21-1和肺癌概率阳性率高于良性病变组(P<0.05)。肿瘤标志物联合检测肺癌的敏感性、特异性、准确性分别为72.37%、73.17%、72.65%。应用肺癌概率模型计算每例肺部结节的肺癌概率,受试者工作特征(ROC)曲线下面积为0.743>0.7。选取肺癌概率的截断点为28.5%,敏感性、特异性、准确性分别为63.16%、78.05%、68.68%。两种方法联合检测肺癌的敏感性、特异性和准确性分别为93.42%、68.29%、92.31%,与单纯使用肿瘤标志物或肺癌概率模型相比,敏感性和准确性都显著提高(P<0.01)。结论肿瘤标志物联合肺癌概率模型可显著提高肺部结节诊断的敏感性和准确性,为肺部结节的鉴别诊断提供重要临床参考价值。
Objective To investigate the value of tumor markers and lung cancer probability models in the differential diagnosis of pulmonary nodules. Methods A total of 117 patients with pulmonary nodules who were diagnosed and treated from January 2013 to January 2016 were divided into lung cancer group (76 cases) and benign lesion group (41 cases) according to the pathological results. Analysis of tumor markers, lung cancer probability model in the differential diagnosis of pulmonary nodulation value. Results The positive rates of carcinoembryonic antigen, carbohydrate antigen 125, neuron specific enolase, cytokeratin 19 fragment antigen 21-1 and lung cancer in lung cancer group were higher than those in benign disease group (P <0.05). The sensitivity, specificity and accuracy of tumor markers in detecting lung cancer were 72.37%, 73.17% and 72.65% respectively. The probability of lung cancer was calculated for each lung nodule using the lung cancer probability model. The area under the receiver operating characteristic (ROC) curve was 0.743> 0.7. The cut-off point for the probability of selecting lung cancer was 28.5%. The sensitivity, specificity and accuracy were 63.16%, 78.05% and 68.68% respectively. The sensitivity, specificity and accuracy of the two methods for the detection of lung cancer were 93.42%, 68.29% and 92.31%, respectively, which were significantly higher than those of using the tumor marker alone or the probability model of lung cancer (P < 0.01). Conclusion The combination of tumor markers and lung cancer probability model can significantly improve the sensitivity and accuracy of lung nodule diagnosis and provide important clinical reference value for the differential diagnosis of pulmonary nodules.