高场强MRI联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期的价值分析

  目的  分析高场强MRI联合血清细胞角蛋白19片段(CYFRA21-1)、糖类抗原72-4(CA72-4)、癌症抗原125(CA125)鉴别食管癌T分期的价值。  方法  选取2017年7月—2020年1月在上海交通大学医学院附属瑞金医院、湖州市中心医院拟行手术治疗的食管癌患者104例为研究对象，分析高场强MRI的图像质量，高场强MRI及其联合血清CYFRA21-1、CA72-4、CA125，采用Kappa一致性分析鉴别食管癌T分期的价值。  结果  高场强MRI图片质量2分6例、3分16例、4分40例、5分42例；高场强MRI诊断食管癌T分期的准确率为92.30%(96/104)，高场强MRI联合血清CYFRA21-1、CA72-4、CA125诊断食管癌T分期的准确率为95.19%(99/104)，与单一MRI诊断食管癌T分期的准确率差异有统计学意义(P＜0.05)；但诊断T2分期的特异度、准确率、阳性预测值，诊断T3分期的敏感度、特异度、准确率、阳性预测值、阴性预测值，诊断T4a分期的敏感度、准确率、阴性预测值均较单一高场强MRI诊断上升。  结论  单一高场强MRI或联合血清CYFRA21-1、CA72-4、CA125鉴别食管癌T分期均可获得良好效能，联合诊断效能略有提升。 

Value of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 in identifying T staging of oesophageal cancer

  Objective  To analyse the value of high-strength MRI combined with serum cytokeratin 19 fragment (CYFRA21-1), carbohydrate antigen 72-4 (CA72-4) and carbohydrate antigen 125 (CA125) in identifying T staging of oesophageal cancer.  Methods  From July 2017 to January 2020, 104 patients with esophageal cancer who were to be surgically treated in Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine and Huzhou Central Hospital were selected as research objects. The image quality of high-field-intensity MRI and the value of high-field-intensity MRI combined with serum CYFRA21-1, CA72-4, CA125 were analysed. Kappa consistency analysis was used in identifying T staging of oesophageal cancer.  Results  There were 6 cases with high-strength MRI image quality scoring 2 points, 16 cases scoring 3 points, 40 cases scoring 4 points and 42 cases scoring 5 points. The accuracy of high-strength MRI for the diagnosis of T staging of oesophageal cancer was 92.30% (96/104). The accuracy rate of high-strength MRI combined with serum CYFRA21-1, CA72-4 and CA125 for the diagnosis of T staging of oesophageal cancer was 95.19% (99/104), which was significantly different from that of single MRI (P < 0.05). However, the specificity, accuracy, positive predictive value for stage T2; sensitivity, specificity, accuracy, positive predictive value, negative predictive value for stage T3; and sensitivity, accuracy, negative predictive value for stage T4a of combined diagnosis were higher than those of single high-strength MRI.  Conclusion  Single high-strength MRI or its combination with serum CYFRA21-1, CA72-4 and CA125 can effectively identify the T staging of oesophageal cancer, and the efficiency of combined diagnosis is slightly improved.