SPECT同机定位CT引导经皮肺穿刺活检术联合肿瘤标志物检测对周围型肺癌的诊断价值

目的探讨SPECT的同机定位CT引导经皮肺穿刺活检术联合肿瘤标志物检测对周围型肺癌的诊断价值。方法回顾性分析275例周围型肺占位患者，均行SPECT同机定位CT引导下肺穿刺活检术，取材样本长1.0~1.5 cm，并结合肿瘤标志物检测，评价其在周围型肺癌诊断中的价值。采用SPSS13.0软件进行统计学分析，组间比较采用t检验或是近似t检验。结果275例经皮肺穿刺活检术均穿刺成功，穿刺成功率为100%。肺穿刺活检诊断周围型肺癌的灵敏度、特异度、准确率分别为97.01%、100%、97.82%。非小细胞肺癌（NSCLC）与小细胞肺癌（SCLC）的血清癌胚抗原、细胞角蛋白19片段21-1值之间的差异无统计学意义（t=1.081、0.666，均P > 0.05），SCLC的神经元特异烯醇化酶（NSE）值高于NSCLC，差异有统计学意义（t=3.671，P < 0.05）；NSE值受试者工作特征曲线下面积为0.935，最佳诊断界值点为26.86 ng/mL，取26.86 ng/mL作为阈值鉴别SCLC与NSCLC所得的灵敏度、特异度分别为91.34%、84.92%。结论SPECT同机定位CT引导下经皮肺穿刺活检术是可行的，对周围型肺癌具有较高的诊断准确率，NSE值有助于鉴别SCLC和NSCLC。

Diagnostic value of lung biopsy through SPECT with CT-guided percutaneous paracentesis and tumor markers for peripheral lung cancer

ObjectiveTo explore the diagnostic value of SPECT localization and CT-guided percutaneous lung biopsy and tumor markers in peripheral lung cancer.MethodsA total of 275 patients with peripheral lung neoplasms were retrospectively analyzed. Pathological diagnosis was performed by SPECT with localizable CT-guided lung biopsy. The value of this imaging modality in combination with tumor markers in diagnosing lung cancer was evaluated. T-test or approximate t-test were used for data analysis using SPSS13.0 software.ResultsAll of the lung biopsies were successful. The sensitivity, specificity, and accuracy for lung cancer diagnosis were 97.01%, 100%, and 97.82%, respectively. No significant difference in carcino-embryonic antigen and CYFRA21-1 values was detected between non-small-cell lung cancer and small-cell lung cancer(t=1.081, 0.666, both P>0.05). However, the neuron-specific enolase(NSE) value of small-cell lung cancer(SCLC) was significantly higher than that of non-small-cell lung cancer(NSCLC), and the difference was statistically significant(t=3.671, P < 0.05). The area under the receiver operating curve of NSE was 0.935. The cut-off value of the diagnostic critical of NSE was 26.86 ng/mL, with a sensitivity of 91.34% and specificity of 84.92%.ConclusionsSPECT with localizable CT-guided percutaneous lung biopsy is feasible and highly accurate for diagnosis of peripheral lung cancer. In addition, NSE is useful in the identification of SCLC and NSCLC.