全身骨显像与肿瘤标志物联合检测对NSCLC骨转移的诊断价值

  目的  探讨全身骨显像和血清肿瘤标志物（CEA、CA125、CYFRA21-1）联合检测对非小细胞肺癌（non-small cell lung cancer，NSCLC）患者骨转移诊断的临床应用价值。  方法  回顾性分析广西医科大学附属肿瘤医院2014年1月至2016年6月185例首诊且经病理或细胞学检查确诊为NSCLC患者的全身骨显像及血清肿瘤标志物（CEA、CA125、CYFRA21-1）检测结果，计算单项检查与联合检查诊断骨转移效能。参照Soloway分级标准将NSCLC骨转移患者的全身骨显像结果进行分级。应用Spearman相关分析评价全身骨显像分级与血清肿瘤标志物水平的相关性。  结果  185例NSCLC患者中78例发生骨转移，骨转移发生率为42.16%（78/185）；全身骨显像诊断NSCLC骨转移的灵敏度、特异性分别为91.02%（71/78）、85.98%（92/107）。NSCLC骨转移组CEA、CA125及CYFRA21-1水平高于NSCLC无骨转移组，差异具有统计学意义（P < 0.05）；78例NSCLC骨转移患者中，EOD 0:8.98%（7/78），EOD 1:50.00%（39/78），EOD 2:21.79%（17/78），EOD 3:19.23%（15/78）。Spearman相关分析结果显示，全身骨显像分级与CEA、CA125及CYFRA21-1水平存在相关性（r_s=0.579、0.274、0.327，均P < 0.05）。全身骨显像与肿瘤标志物联合检测NSCLC骨转移诊断效能高于各项单项检测效能（AUC=0.922），灵敏度及特异性均提高（分别为92.30%、86.00%）。  结论  全身骨显像对诊断NSCLC骨转移的诊断效能较高，适宜作为NSCLC骨转移的首选筛查方法，在临床中具有重要应用价值。全身骨显像联合CEA、CA125、CYFRA21-1检测比单项检测有助于提高NSCLC骨转移病灶检出率，临床实用性更强。 

Diagnostic value of whole body bone scintigraphy combined with tumor markers for bone metastases of non-small cell lung cancer

  Objective   To explore the diagnostic value and efficiency of using whole body bone scintigraphy (WBS) combined with thelevels of tumor markers to evaluate non-small cell lung cancer (NSCLC) patients with bone metastases.  Methods   One-hundred andeighty-five cases of NSCLC, confirmed by pathology or cytological examination from January 2014 to June 2016, were emrolled fromthe Affiliated Tumor Hospital of Guangxi Medical University. WBS and test results of tumor markers, such as serum carcinoembryonicantigen (CEA), serum carbohydrate antigen (CA125), and cytokeratin CK19 (CYFRA21-1), were analyzed. WBS results were assessed bythe Soloway classification criteria and divided into four grades: Correlations between WBS classification and the levels of tumor markers were determined with Spearman correlation analyses.  Results   Seventy-eight of the 185 NSCLC patients had bone metastases (arate of 42.16%). The sensitivity and specificity of WBS were 91.02% (71/78) and 85.98% (92/107), respectively. The CEA, CA125, andCYFRA21-1 levels in bone metastases patients were higher than those in NSCLC patients without bone metastases (P < 0.05). In the 78patients with bone metastases, there were seven cases of EOD0 (8.98%), 39 cases of EOD1 (50%), 17 cases of EOD2 (21.8%), and 15cases of EOD3 (19.2%). The correlations between WBS grade and CEA, CA125, and CYFRA21-1 levels were: r_s=0.579, 0.274, and 0.327, respectively (P < 0.05). The combined WBS and tumor marker diagnostic performance was significantly better than either alone (AUC=0.922), and their sensitivity and specificity increased (92.3% and 86.0%, respectively).  Conclusions  WBS shows high clinical efficacy inthe diagnosis of NSCLC with bone metastases. Furthermore, it can be used as a screening test for bone metastases of NSCLC, whichhas important clinical implications. WBS combined with CEA, CA125, and CYFRA21- 1 examination improves the detection rate ofNSCLC bone metastases, thereby enhancing its clinical utility.