血清CA153、TPS、CYFRA21-1检测联合钼靶X摄影在乳腺癌早期诊断中的价值

目的 探索在乳腺癌诊断中血清糖类抗原153(carbohydrate antigen 153,CA153)、组织多肽特异性抗原 (tissue polypeptide specific antigen,TPS)、细胞角质蛋白19片段(cytokeratin 19 fragment antigen 21-1,CYFRA21-1)、钼靶X摄影单独检测和联合检测的临床价值。方法 选取2015年1月—2016年12月在唐山市人民医院住院治疗的42例早期乳腺癌患者和42例乳腺良性病变患者,均经组织病理证实,乳腺癌TNM分期为Ⅰ、Ⅱ期的患者30例,Ⅲ、Ⅳ期患者12例。均行钼靶X摄影及CA153、TPS、CYFRA21-1水平检测,然后比较良性组与Ⅰ+Ⅱ期乳腺癌组与Ⅲ+Ⅳ期乳腺癌组血清CA153、TPS、CYFRA21-1水平;比较血清CA153、TPS、CYFRA21-1、钼靶X摄影单项与联合检测结果与病理诊断;比较血清CA153、TPS、CYFRA21-1、钼靶单项检测及联合检测对乳腺癌诊断的价值;通过ROC工作曲线分析诊断试验的价值。结果 乳腺癌组患者血清CA153、TPS、CYFRA21-1水平较良性组升高,差异有统计学意义(P<0.05),Ⅲ+Ⅳ期乳腺癌组血清CA153、TPS、CYFRA21-1水平较Ⅰ+Ⅱ期乳腺癌组明显升高,差异有统计学意义(P<0.05)。血清CA153、TPS、CYFRA21-1及钼靶四项联合检测时,灵敏度为80.0%,特异度为94.1%,Youden指数为74.1%,而误诊率为5.9%、漏诊率为20.0%。四项联合的诊断试验曲线下面积(area under the curve, AUC)最大,AUC_四项联合>AUC_{CA153+TPS+CYFRA21-1}>AUC_CYFRA21-1>AUC_CA153>AUC_TPS>AUC_钼靶,曲线下面积差异均有统计学意义(P<0.05)。结论 联合检测血清CA153、TPS、CYFRA21-1及钼靶X摄影在乳腺癌早期诊断中具有重要的临床价值。

Clinical value of serum CA153, TPS,CYFRA21-1 and molybdenum target X photography detection in early diagnosis of breast cance

Objective To explore the clinical value of single and combination detection of CA153, TPS,CYFRA21-1 and molybdenum target X photography in breast cancer diagnosis. Methods Totally 42 patients with early breast cancer and 42 patients with breast benign lesions were selected in Tangshan People's Hospital in Jan. 2015 - Dec. 2016, which were confirmed by histopathologic, TNM staging of breast cancer patients with stage Ⅰ and Ⅱ of 30 patients, 12 patients with stage Ⅲ and Ⅳ. All patients did molybdenum target X-ray photography and CA153, TPS, CYFRA21-1 level detection, then compared the serum CA153, TPS, CYFRA21-1 levels of the benign group, Ⅰ + Ⅱ breast cancer group and Ⅲ + Ⅳ breast cancer group; and the the single and combined test Results of serum CA153, TPS, CYFRA21-1, molybdenum target X photography and the pathological diagnosis were compared; serum CA153, TPS,CYFRA21-1, molybdenum target X single detection and combined detection of breast cancer diagnosis value were compared; The value of diagnostic test was analyzed by ROC working curve. Results The serum CA153, TPS and CYFRA21-1 levels in the breast cancer group were significantly higher than the benign group, and the difference was statistically significant (P < 0.05).The serum CA153, TPS and CYFRA21-1 levels of the Ⅲ + Ⅳ breast cancer group were significantly higher than that in the Ⅰ + Ⅱ breast cancer group, and the difference was statistically significant (P < 0.05).The sensitivity of serum CA153, TPS, CYFRA21-1 and molybdenum target was 80.0%, the specificity was 94.1%, the Youden index was 74.1%, and the misdiagnosis rate was 5.9%, and the missed diagnosis rate was 20.0%.Under the four joint diagnostic test curves, the area was the largest, with the AUC _{the four joint combined} > AUC_{CA153 + TPS + TPS +CYFRA21-1} > AUC_CYFRA21-1 > AUC_CA153> AUC_TPS > AUC_{molybdenum target}, the area of the curve was statistically significant (P<0.05). Conclusion Combined detection of serum CA153, TPS, CYFRA21-1 and molybdenum target X photography has important clinical value in early diagnosis of breast cancer.