SPECT/CT断层融合显像联合血清CEA、CYFRA21-1在诊断非小细胞肺癌骨转移中的应用

Application of SPECT/CT tomographic fusion imaging combined with serum CEA and CYFRA21-1 in the diagnosis of bone metastasis of non-small cell lung cancer

    摘要
  • 摘要:
    目的研究SPECT/CT断层融合显像联合血清肿瘤标志物癌胚抗原（CEA）、可溶性细胞角蛋白19片段（CYFRA21-1）在诊断非小细胞肺癌（NSCLC）骨转移中的应用。
    方法选取143例经病理确诊为NSCLC的患者（腺癌88例，鳞癌55例），抽取其静脉血测定血清CEA、CYFRA21-1的水平，并行全身骨显像和SPECT/CT融合显像。血清CEA、CYFRA21-1之间的比较采用Mann-Whitney U秩和检验。血清CEA、CYFRA21-1水平与骨转移数目的相关性采用Spearman相关性分析；肺腺癌和肺鳞癌骨转移的发生率、骨转移灶数目、全身骨显像、SPECT/CT同机断层融合显像与血清CEA、CYFRA21-1单用或联合应用诊断骨转移的灵敏度、特异度和准确率的比较采用χ2检验。
    结果68例患者证实发生骨转移，病灶共有586个。腺癌骨转移发生率（50/88）高于鳞癌（18/55）（χ2=10.56，P < 0.05）；腺癌骨转移病灶数比例（526/586）大于鳞癌（χ2=19.23，P < 0.05）；骨转移患者的血清CEA（Z=4.98，P < 0.05）、CYFRA21-1（Z=2.55，P < 0.05）水平高于未发生骨转移患者；NSCLC骨转移患者血清CEA与骨转移灶的数目无显著相关性（r=0.141，P>0.05），而CYFRA21-1与骨转移灶的数目具有一定相关性（r=0.502，P < 0.01）。血清CEA、CYFRA21-1水平诊断NSCLC骨转移具有一定的灵敏度（69.1%、83.8%），但特异度（47.6%、49.3%）、准确率（57.3%、65.7%）较低，而SPECT/CT同机断层融合显像在诊断NSCLC骨转移时具有较高的灵敏度（83.8%）、特异度（84.0%）、准确率（83.9%），高于血清CEA（χ2=4.09、23.08、24.33，均P < 0.05），特异度和准确率高于CYFRA21-1（χ2=20.28、12.55，均P < 0.05）及全身骨显像（χ2=21.66、16.05，均P < 0.05）。而SPECT/CT同机断层融合显像联合血清CEA及CYFRA21-1诊断NSCLC骨转移的灵敏度（97.0%）、特异度（93.3%）、准确率（95.1%）分别高于血清CEA（χ2=18.89、38.89、24.33，均P < 0.05）、CYFRA21-1（χ2=6.89、35.50、39.17，均P < 0.05）、单独应用全身骨显像（χ2=12.55、37.17、47.45，均P < 0.05），灵敏度、准确率高于单独应用SPECT/CT同机断层融合显像（χ2=6.89、9.53，均P < 0.05）。
    结论SPECT/CT断层融合显像联合血清CEA、CYFRA21-1诊断NSCLC骨转移的发生具有较高的灵敏度、特异度、准确率，在临床工作中具有一定的应用价值。

     

    Abstract:
    ObjectiveThis study aims to study the role of SPECT/CT tomographic fusion imaging in combination with serum tumor markers such as CEA and CYFRA21-1 to diagnose bone metastasis of NSCLC.
    MethodsA total of 143 patients with pathologically confirmed NSCLC were selected as study subjects(adenocarcinoma 88 cases, squamous cell 55 cases). Venous blood samples were collected to determine the serum levels of CEA and CYFRA21-1, and a whole body bone scan and SPECT/CT tomographic fusion imaging was performed. SPSS 22.0 software was used to compare serum CEA with CYFRA21-1 with the Mann-Whitney U rank sum test. Spearman correlation analysis was used to correlate serum CEA and CYFRA21-1 levels with the number of bone metastases. Sensitivity, specificity, and accuracy in the diagnosis of bone metastases were needed to detect the incidence of bone metastases in lung adenocarcinoma and squamous cell carcinoma of the lung via whole-body bone imaging and SPECT/CT fusion imaging with serum and serum CEA and CYFRA21-1(alone or in combination with the χ2 test).
    Results68 patients demonstrated bone metastasis with a total of 586 lesions. The incidence of bone metastasis of adenocarcinoma(50/88) was higher than that of squamous cell carcinoma(18/55)(χ2=10.56, P < 0.05). The ratio of bone metastatic lesions in adenocarcinoma patients was greater than that in squamous carcinoma(526/586)(χ2=19.23, P < 0.05). The serum levels of CEA(Z=4.98, P < 0.05) and CYFRA21-1(Z=2.55, P < 0.05) in patients with bone metastases were higher than in those without bone metastases. However, no significant correlation was found between serum CEA and bone metastases in non-small cell lung cancer patients with bone metastases(r=0.141, P>0.05), but there was a certain correlation between CYFRA21-1 and the number of bone metastases(r=0.502, P < 0.01). Serum CEA and CYFRA21-1 levels were sensitive in the diagnosis of NSCLC bone metastasis(69.1%, 83.8%), but had low specificity(47.6%, 49.3%) and accuracy(57.3%, 65.7%) was low. The SPECT/CT tomographic fusion imaging in the diagnosis of NSCLC bone metastasis had high sensitivity(83.8%), specificity(84.0%), and accuracy(83.9%) were higher than serum CEA(χ2=4.09、23.08、24.33, all P < 0.05), specificity and accuracy were higher than CYFRA21-1 (χ2=20.28、12.55, both P < 0.05) and whole body bone scan(χ2=21.66、16.05, both P < 0.05). The sensitivity(97.0%), specificity(93.3%), and accuracy(95.1%) of SPECT/CT tomographic fusion imaging combined with serum CEA and CYFRA21-1 in the diagnosis of NSCLC bone metastasis were higher than those of whole body bone scan(χ2=12.55、37.17、47.45, all P < 0.05), serum CEA(χ2=18.89、38.89、24.33, all P < 0.05), CYFRA21-1 (χ2=6.89、35.50、39.17, all P < 0.05), sensitivity and accuracy were higher than SPECT/CT tomographic fusion imaging(χ2=6.89、9.53, both P < 0.05) applied individually.
    ConclusionsSPECT/CT tomographic fusion imaging combined with serum CEA and CYFRA21-1 diagnosis of NSCLC bone metastases had clinical value because of high sensitivity, specificity, and accuracy.

     

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