肿瘤标志物癌胚抗原（CEA）、细胞角蛋白标志物（CYFRA 21-1）和神经元特异性烯醇化酶（NSE）在鉴别孤立性肺良性病变与恶性病变中的评估。

An evaluation of the tumour markers, carcinoembryonic antigen (CEA), cytokeratin marker (CYFRA 21-1) and neuron-specific enolase (NSE) in the differentiation of malignant from benign solitary pulmonary lesions.

作者信息

Seemann M D, Beinert T, Fürst H, Fink U

机构信息

Department of Diagnostic Radiology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany.

出版信息

Lung Cancer. 1999 Dec;26(3):149-55. doi: 10.1016/s0169-5002(99)00084-7.

DOI:10.1016/s0169-5002(99)00084-7

PMID:10598925

Abstract

PURPOSE

The aim of this prospective study was to assess the diagnostic value of the tumour markers carcinoembryonic antigen (CEA), cytokeratin 19 fragment marker (CYFRA 21-1) and neuron-specific enolase (NSE) in the differentiation of malignant (MSPLs) from benign solitary pulmonary lesions (BSPLs).

METHODS

Solitary pulmonary lesions (SPLs) were diagnosed using plain radiography and spiral computed tomography (SCT) and then completely removed by surgery in 104 consecutive patients (MSPLs; n = 81, BSPLs; n = 23). The serum concentrations of the tumour markers were determined 1-3 days prior to surgery by ELISA for CEA and CYFRA 21-1 and by IRMA for NSE using commercially available assay kits. The cut-off values were set at 3 ng/ml (for non-smokers) and 5 ng/ml (for smokers) for CEA, at 3.3 ng/ml for CYFRA 21-1 and at 12.5 ng/ml for NSE.

RESULTS

MSPLs were identified with a sensitivity between 13.6 and 45.7%, a specificity between 87.0 and 100% and an accuracy between 32.7 and 54.8%. Using the tumour markers alone, the highest sensitivity (27.2%) and accuracy (40.4%) was found with CEA, the highest specificity (100%) with CYFRA 21-1 and with NSE. Primary lung cancers (n = 39) were identified with a sensitivity between 17.9 and 61.5%, a specificity between 87.0 and 100% and an accuracy between 48.4 and 71.0%. Using the tumour markers alone, the highest sensitivity (35.9%) and accuracy (59.7%) was found with CYFRA 21-1, the highest specificity (100%) with CYFRA 21-1 and with NSE. The combination of all three tumour markers resulted in a greater sensitivity and greater diagnostic accuracy but a loss in specificity compared with CYFRA 21-1 and NSE.

CONCLUSION

The use of the tumour markers alone or in combination showed a low sensitivity and low accuracy for the diagnostic differentiation of MSPLs from BSPLs and primary lung cancers from BSPLs. However, both CYFRA 21-1 and NSE exhibited a specificity of 100% and may be useful complements to standard clinical imaging methods.

摘要

目的

本前瞻性研究旨在评估肿瘤标志物癌胚抗原（CEA）、细胞角蛋白19片段标志物（CYFRA 21-1）和神经元特异性烯醇化酶（NSE）在鉴别恶性孤立性肺病变（MSPLs）与良性孤立性肺病变（BSPLs）中的诊断价值。

方法

采用胸部X线平片和螺旋计算机断层扫描（SCT）诊断孤立性肺病变（SPLs），随后对104例连续患者（MSPLs；n = 81，BSPLs；n = 23）的病变进行手术完全切除。术前1-3天，采用ELISA法检测CEA和CYFRA 21-1的血清浓度，采用免疫放射分析法（IRMA）检测NSE的血清浓度，使用市售检测试剂盒。CEA的临界值设定为3 ng/ml（非吸烟者）和5 ng/ml（吸烟者），CYFRA 21-1为3.3 ng/ml，NSE为12.5 ng/ml。

结果

MSPLs的诊断敏感性为13.6%至45.7%，特异性为87.0%至100%，准确性为32.7%至54.8%。单独使用肿瘤标志物时，CEA的敏感性最高（27.2%）和准确性最高（40.4%），CYFRA 21-1和NSE的特异性最高（100%）。原发性肺癌（n = 39）诊断的敏感性为17.9%至61.5%，特异性为87.0%至100%，准确性为48.4%至71.0%。单独使用肿瘤标志物时，CYFRA 21-1的敏感性最高（35.9%）和准确性最高（59.7%），CYFRA 21-1和NSE的特异性最高（100%）。与CYFRA 21-1和NSE相比，三种肿瘤标志物联合使用可提高敏感性和诊断准确性，但特异性降低。