| Objective Our study was designed to study the value of miRNAs be a serum tumor markers in benign and malignant pulmonary nodules;and joint clinical features,imaging features and tumor markers to improve the accuracy of the determination of benign and malignant pulmonary nodules.Methods Collected from March 2015 to November 2015 in our hospital for the first time discovered by chest CT pulmonary nodules(diameter 5-30mm)of patients,recording the clinical features(age,sex,smoking history,smoking,family history of cancer,emphysema),imaging features(nodules position,nodule diameter,nodule density edge feature nodules,calcification,signs of the trachea,vascular sign,vacuole sign,there no pleural stretch),and collected the serum before it did not receive any treatment.There are 51 patients by surgery or bronchoscopic biopsy got pathology information.The patients were divided into benign and malignant pulmonary nodules.Using ELISA kits to detect tumor markers such as NSE、CEA、CYFRA21-1;Using q RT-PCR to detect the relative expression in serum of mi R-574-5p and mi RNA-21-5p.By univariate analysis,to find a significant difference in the differential diagnosis of benign and malignant pulmonary nodules factors;Establish clinical malignant pulmonary nodules forecasting model by Fisher’s Test.Application of ROC curve reflects joint clinical features,imaging features nodules,serum markers to determine the accuracy of benign and malignant nodules.Results There are 23 patients of benign nodules and 28 patients of malignant nodules.Clinical Information: benign and malignant nodules group the age were(54.2 ± 2.33)yr,(64.5±1.84)yr,smoking was(197±7.8)/ yr,(446±91.6)/ yr,the age of malignant nodules group was significantly higher,smoking was significantly above(P <0.05);The gender,smoking history,family history of cancer and emphysema are compared,there are no significant difference in two groups(P> 0.05).Imaging Information:Diameter between benign and malignant nodules group respectively was(16.70±1.53)mm and(21.71±1.23)mm,burr sign constituent ratio was 34.8% and 67.9%,vacuole sign was0 and 25%,vascular sign was 0 and 28.6%,the diameter of malignant nodules was significantly longer,the probability of burr sign,vacuoles,vascular sign more possible(P <0.05);The nodule location,density,calcification,symptoms trachea,pleura,etc.in stretch,the difference was not significant(P> 0.05).Serum tumor markers: The CYFRA21-1 serum levels were(2.054±0.781)ng / m L,(4.139±4.832)ng / m L respectively beween benign and malignant nodules groups,malignant nodules group were significantly increased(P <0.05);and CEA was(1.214±0.773)ng / ml and(6.738±15.55)ng / m L;NSE was(16.768±4.229)ng / m L and(16.485±5.870)ng /m L,the difference was not significant in two groups(P> 0.05).mi RNA-21-5p,mi RNA-574-5p expression in serum of the malignant nodules Respectively was 2.00 and 2.06,compared with benign nodule group was significantly increased(P <0.05).In malignant pulmonary nodules,There are 6 cases of squamous cell carcinoma,20 cases of adenocarcinoma,2 cases of neuroendocrine carcinoma;the relative expression of mi RNA-574-5p in the three groups were(6.71±4.26),(2.30±1.97),(2.06±0.02),expression in squamous cell carcinoma compared with adenocarcinoma and neuroendocrine carcinoma was significantly higher(P <0.05);But the expression of mi RNA-21-5p was no difference(P> 0.05).No malignant nodules if the diameter of nodule smaller than 8mm;The diameter between 8-15 mm,malignant nodules 36.36%,the expression of mi RNA-21-5p and mi RNA-574-5p respectively was(1.45±0.85),(1.60± 1.88);between 15-30 mm,malignant nodules accounted for 63.16%,the expression of mi RNA-21-5p and mi RNA-574-5p respectively was(1.82±0.99)and(2.47±2.72),there was no significant difference in three groups(P> 0.05).Joint thesefactors clinical features,imaging features and serum tumor markers,which has significant difference in two groups,establish Fisher discriminant function,cross validation that the accuracy of the original case is 92.2%.Draw ROC curve,judge the benign and malignant pulmonary nodules by the clinical features alone,AUC was 0.71,95% CI(0.566,0.855);when combined with clinical features and imaging features,AUC was 0.885,95% CI(0.798,0.972);clinical features and imaging features combined with serum tumor markers CYFRA21-1,AUC was 0.921,95% CI(0.851,0.991).Conclusions 1The clinical information that age and smoking and the imaging information that diameter,burrs,vascular sign,vacuole sign of pulmonary nodule and serum CYFRA21-1、mi RNA-21-5p、mi RNA-574-5p are meaningful for Identification of benign and malignant pulmonary nodules.Mi RNA-574-5p expression in squamous cell carcinoma was significantly higher than adenocarcinoma.2 Joint Clinical characteristics of patients,imaging characteristics,tumor markers can improve the accuracy of determining the nature of pulmonary nodules,it has important clinical significance for the early diagnosis of lung cancer. |
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