基于常规超声及超声造影特征联合肿瘤标志物对胃肠道间质瘤肝转移与结直肠癌肝转移的鉴别诊断
Differential diagnosis of liver metastases of gastrointestinal stromal tumors from colorectal cancer based on combined tumor biomarker with features of conventional ultrasound and contrast-enhanced ultrasound.
机构信息
Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, NO.58 Zhongshan Road 2, Guangzhou, 510080, People's Republic of China.
出版信息
Abdom Radiol (NY). 2020 Sep;45(9):2717-2725. doi: 10.1007/s00261-020-02592-6.
PURPOSE
To explore the value of tumor marker CA125 and CEA linked with conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) features in differentiating gastrointestinal stromal tumors liver metastases (GISTLM) from colorectal cancer liver metastases (CRCLM).
MATERIALS AND METHODS
From December 2005 to February 2019, eighty patients with pathologically proven GISTLM together with 80 CRCLM patients were retrospectively evaluated with contrast-enhanced ultrasound (CEUS). Clinical characteristics such as CA125 and CEA were documented to compare the difference between GISTLM and CRCLM. Univariate analysis was performed to determine significant features in ultrasound and then these features were entered into multivariate logistic regression model to determine diagnostic criteria. By analyzing the tumor marker and imaging features, diagnostic performance was evaluated via receiver-operating characteristic (ROC) analysis. The sensitivity, specificity and accuracy were calculated for the diagnosis of GISTLM.
RESULTS
Multiple logistic regression analysis showed that increased CA125 and normal CEA were the independent variables of GISTLM. On conventional US, the features of hypo- or mix-echogenicity and anechoic area were associated with GISTLM. On CEUS, capsule enhancement, starting time of washout > 40 s and proportion of non-enhancement area > 20% were the features indicating GISTLM. All of the p values were < 0.05. When linking tumor marker with imaging features, the diagnostic sensitivity improved from 36.3-57.5% to 70.0%, and the area under the ROC (AUROC) curve improved from 0.681-0.750 to 0.838, with a specificity of 97.5%.
CONCLUSIONS
Combining the imaging features of conventional US and CEUS with serum tumor markers provides a potentially effective diagnostic method in differentiation of GISTLM and CRCLM.
目的
探讨肿瘤标志物 CA125 和 CEA 联合常规超声（US）和超声造影（CEUS）特征在鉴别胃肠道间质瘤肝转移（GISTLM）与结直肠癌肝转移（CRCLM）中的价值。
材料与方法
回顾性分析 2005 年 12 月至 2019 年 2 月 80 例经病理证实的 GISTLM 患者和 80 例 CRCLM 患者的超声造影资料。记录 CA125 和 CEA 等临床特征，比较 GISTLM 与 CRCLM 之间的差异。进行单因素分析，确定超声特征中的显著特征，然后将这些特征纳入多因素逻辑回归模型，确定诊断标准。通过分析肿瘤标志物和影像学特征，利用受试者工作特征（ROC）曲线分析评估诊断性能。计算 GISTLM 的诊断敏感性、特异性和准确性。
结果
多因素逻辑回归分析显示，CA125 升高和 CEA 正常是 GISTLM 的独立变量。在常规 US 上，低回声或混合回声和无回声区是 GISTLM 的相关特征。在 CEUS 上，包膜增强、洗脱开始时间＞40 s 和非增强区比例＞20%是提示 GISTLM 的特征。所有 p 值均＜0.05。当将肿瘤标志物与影像学特征相结合时，诊断敏感性从 36.3%-57.5%提高到 70.0%，ROC 曲线下面积（AUROC）从 0.681-0.750 提高到 0.838，特异性为 97.5%。
结论
联合常规 US 和 CEUS 的影像学特征与血清肿瘤标志物可提供一种有效鉴别 GISTLM 和 CRCLM 的诊断方法。
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