低剂量胸部CT与癌胚抗原、Cyfra21-1水平在早期肺癌检查中的价值

目的  探讨低剂量胸部CT扫描与癌胚抗原（CEA）、细胞角蛋白19片段抗原（Cyfra21-1）在早期肺癌检查中的价值。 方法  选取2019年1月~2021年1月在我院就诊的肺部亚实性结节患者108例，均给予低剂量CT扫描，经病理确诊为早期肺癌患者76例（其中原位癌34例，微浸润性癌22例，浸润性癌20例），非肺癌患者32例，比较肺癌和非肺癌患者血清CEA、Cyfra21-1水平差异，分析CT联合血清CEA、Cyfra21-1诊断早期肺癌的价值。 结果  肺癌患者血清CEA、Cyfra21-1明显高于非肺癌患者（P < 0.05）；CT联合血清CEA、Cyfra21-1诊断早期肺癌的敏感度和阴性预测值明显高于CT检查（P < 0.05）；浸润性癌病灶直径、CT值明显高于原位癌和微浸润性癌（P < 0.05）；原位癌、微浸润性癌和浸润性癌患者CEA、Cyfra21-1的差异无统计学意义（P>0.05）；病灶直径、CT值诊断浸润性癌的ROC曲线下面积分别为0.941和0.816（P < 0.05），截断值分别为15.86 mm和-422.52 Hu，敏感度分别为90.00%和65.00%，特异性分别为91.10%和89.30%。 结论  低剂量胸部CT与CEA、Cyfra21-1水平在早期肺癌诊断中有较好的价值，同时病灶直径及CT值在鉴别浸润性癌中有一定应用价值。

Value of low-dose chest CT,carcinoembryonic antigen and Cyfra21-1 levels in the diagnosis of early lung cancer

  Objective  To investigate the value of low-dose chest CT scan, carcinoembryonic antigen (CEA) and cytokeratin 19 fragment antigen (Cyfra21-1) in the diagnosis of early lung cancer.  Methods  A total of 108 patients with pulmonary sub solid nodules from January 2019 to January 2021 in our hospital were selected. All patients were given low-dose CT scanning. The serum CEA and CYFRA21-1 in patients with lung cancer and non lung cancer were compared, and the value of CT combined with serum CEA and CYFRA21-1 in the diagnosis of early lung cancer was analyzed.  Results  Seventy-six patients were pathologically diagnosed as early lung cancer (including 34 cases of carcinoma in situ, 22 cases of micro invasive carcinoma and 20 cases of invasive carcinoma), and 32 patients were non lung cancer. The serum CEA and Cyfra21-1 in lung cancer patients were significantly higher than those in non-lung cancer patients (P < 0.05). The sensitivity and negative predictive value of CT combined with serum CEA and Cyfra21-1 in the diagnosis of early lung cancer were significantly higher than that of CT (P < 0.05). The diameter and CT values of invasive carcinoma were significantly higher than those of carcinoma in situ and microinvasive carcinoma (P < 0.05). There was no significant difference in CEA and Cyfra21-1 among patients with carcinoma in situ, microinvasive carcinoma and invasive carcinoma (P>0.05). The area under the ROC curve of lesion diameter and CT value for the diagnosis of invasive carcinoma were 0.941 and 0.816, respectively (P < 0.05), the cut-off value was 15.86 mm and -422.52 Hu respectively. The sensitivity were 90.00% and 65.00%, and the specificity were 91.10% and 89.30% respectively.  Conclusion  Low dose chest CT, CEA and Cyfra21-1 level have good value in the diagnosis of early lung cancer, and lesion diameter and CT value have certain application value in the differentiation of invasive cancer.