Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
Department of Emergency, the First Affiliated Hospital of Zhengzhou University, No. 1 Jianshe East Road, Zheng zhou, Zhengzhou, 450052, Henan, China.
BMC Infect Dis. 2024 Sep 27;24(1):1050. doi: 10.1186/s12879-024-09952-3.
To analyze the value of combining computed tomography (CT) with serum tumor markers in the differential diagnosis of benign and malignant solitary pulmonary nodules (SPNs).
The case data of 267 patients diagnosed with SPNs in the First Affiliated Hospital of Zhengzhou University from March 2020 to January 2023 were retrospectively analyzed. All individuals diagnosed with coronavirus disease 2019 (COVID-19) were confirmed via respiratory specimen viral nucleic acid testing. The included cases underwent CT, serum tumor marker testing and pathological examination. The diagnostic efficacy and clinical significance of CT, serum tumor marker testing and a combined test in identifying benign and malignant SPNs were analyzed using pathological histological findings as the gold standard. Finally, a nomogram mathematical model was established to predict the malignant probability of SPNs.
Of the 267 patients with SPNs, 91 patients were not afflicted with COVID-19, 36 exhibited malignant characteristics, whereas 55 demonstrated benign features. Conversely, within the cohort of 176 COVID-19 patients presenting with SPNs, 62 were identified as having malignant SPNs, and the remaining 114 were diagnosed with benign SPNs. CT scans revealed statistically significant differences between the benign and malignant SPNs groups in terms of CT values (P<0.001), maximum nodule diameter (P<0.001), vascular convergence sign (P<0.001), vacuole sign (P = 0.0007), air bronchogram sign (P = 0.0005), and lobulation sign (P = 0.0005). Malignant SPNs were associated with significantly higher levels of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) compared to benign SPNs (P < 0.05), while no significant difference was found in carbohydrate antigen 125 (CA125) levels (P = 0.054 for non-COVID-19; P = 0.072 for COVID-19). The sensitivity (95.83%), specificity (95.32%), and accuracy (95.51%) of the comprehensive diagnosis combining serum tumor markers and CT were significantly higher than those of CT alone (70.45%, 79.89%, 76.78%) or serum tumor marker testing alone (56.52%, 73.71%, 67.79%) (P < 0.05). A visual nomogram predictive model for malignant pulmonary nodules was constructed.
Combining CT with testing for CEA, CA125, and NSE levels offers high diagnostic accuracy and sensitivity, enables precise differentiation between benign and malignant nodules, particularly in the context of COVID-19, thereby reducing the risk of unnecessary surgical interventions.
分析计算机断层扫描（CT）联合血清肿瘤标志物在鉴别诊断良恶性孤立性肺结节（SPN）中的价值。
回顾性分析 2020 年 3 月至 2023 年 1 月郑州大学第一附属医院收治的 267 例 SPN 患者的病例资料。所有确诊为 2019 年冠状病毒病（COVID-19）的患者均通过呼吸道标本病毒核酸检测进行确诊。纳入的病例均行 CT、血清肿瘤标志物检测和病理检查。以病理组织学发现为金标准，分析 CT、血清肿瘤标志物检测及联合检测对鉴别良恶性 SPN 的诊断效能及临床意义。最后，建立列线图数学模型预测 SPN 恶性概率。
267 例 SPN 患者中，91 例未感染 COVID-19，36 例为恶性特征，55 例为良性特征。相反，在 176 例 COVID-19 患者中，62 例被诊断为恶性 SPN，其余 114 例被诊断为良性 SPN。CT 扫描显示，良性和恶性 SPN 组在 CT 值（P<0.001）、最大结节直径（P<0.001）、血管汇聚征（P<0.001）、空泡征（P=0.0007）、空气支气管征（P=0.0005）和分叶征（P=0.0005）方面存在统计学差异。与良性 SPN 相比，恶性 SPN 癌胚抗原（CEA）和神经元特异性烯醇化酶（NSE）水平显著升高（P<0.05），而碳水化合物抗原 125（CA125）水平无显著差异（非 COVID-19 患者 P=0.054；COVID-19 患者 P=0.072）。血清肿瘤标志物联合 CT 综合诊断的敏感性（95.83%）、特异性（95.32%）和准确性（95.51%）显著高于 CT 单独诊断（70.45%、79.89%、76.78%）或血清肿瘤标志物单独诊断（56.52%、73.71%、67.79%）（P<0.05）。构建了一个用于恶性肺结节的可视化列线图预测模型。
CT 联合 CEA、CA125 和 NSE 水平检测具有较高的诊断准确性和敏感性，能够准确鉴别良恶性结节，尤其是在 COVID-19 背景下，从而减少不必要的手术干预。
