| Background The incidence and mortality of lung cancer are high.Early diagnosis and early intervention will significantly prolong the survival time of patients;and early diagnosis of lung cancer is the difficulty and hot spot in the field of respiratory tumors.Objective To analyze the clinical characteristics of patients and compare with the sensitivity and specificity of thin-slice chest CT scanning,serum tumor markers combined with cryptococcus capsule antigen and combination of the three indicators in the diagnosis of solitary pulmonary nodules(SPN).At the time,analyze the clinical value of different methods in the differential diagnosis of benign and malignant SPN and the risk factors for predicting malignant pulmonary nodules.Methods Patients with SPN diagnosed in Yichang Central people’s Hospital from August2018 to August 2020 were selected as the object of the study.Collect patients’ general data(including age,sex,smoking history,family history of lung cancer,history of chronic basic lung diseases,clinical symptoms,history of dust exposure,etc),thin-slice CT scanning features(nodule diameter,location,morphology,density,internal characteristics,etc),serum tumor markers(including squamous cell carcinoma antigen(SCCA),carcinoembryonic antigen(CEA),neuronspecific enolase(NSE),gastrin releasing peptide precursor(Pro GRP))and cryptococcus capsule antigen.Taking the results of pathological diagnosis as the gold standard,the risk factors for predicting malignant SPN were screened out,and the sensitivity and specificity of simple thin-slice CT scan,serum tumor marker combined with cryptococcus capsule antigen,thin-slice CT scanning combined with serum tumor markers and cryptococcus capsule antigen in the diagnosis of malignant SPN were evaluated.Results A total of 164 cases were collected and divided into benign nodule group and malignant nodule group according to pathological results,including 67 cases(40.9%)in benign nodule group and 97 cases(59.1%)in malignant nodule group.Fungal infection(37.3%)and chronic inflammation(31.3%)accounted for the largest proportion in benign nodule group,while adenocarcinoma(63.9%)accounted for the largest proportion in malignant nodule group.1.The clinical characteristics of benign and malignant nodules : The average age of benign nodules was(45.1±7.3)years,and that of malignant nodules was(59.6±9.5)years.The age of patients with malignant nodules was significantly higher than that of benign nodules(P<0.05).The proportion of patients with smoking history was higher than that of patients with benign nodules(P<0.05).There was no significant difference in gender,family history of malignant tumor,history of chronic lung disease and clinical symptoms between the two groups(all P>0.05).2.The thin-slice CT imaging features of benign and malignant nodules : There were significant differences in pulmonary nodule diameter,lobulation sign,spiculation sign,vascular entanglement sign and location between the two groups(all P<0.05),but there were no significant differences in pleural traction sign,halo sign,calcification,cavity and other imaging features(all P>0.05).In addition,pulmonary nodules of the same pathological type had different imaging features,and different pathological types of pulmonary nodules also had similar imaging features.3.The analysis of serum tumor markers and cryptococcus capsule antigen in benign and malignant nodules :The CEA,SCCA,NSE and Pro GRP of the two groups were analyzed.The results showed that CEA and SCCA in malignant nodules were significantly higher than those in benign nodules(P<0.05),but there was no significant difference in NSE and Pro GRP between the two groups(P>0.05).The expression of cryptococcus capsule antigen was different between the two groups,and the expression in benign nodule group was significantly higher than that in malignant nodule group(P<0.01).4.The analysis of sensitivity and specificity of different diagnostic methods: The sensitivity and specificity of simple Thin-slice CT scanning in the diagnosis of malignant SPN were 77.3% and 74.6%,respectively,and the sensitivity and specificity of serum tumor markers combined with cryptococcus capsule antigen in the diagnosis of malignant SPN were56.7% and 71.6%,respectively.The sensitivity and specificity of Thin-slice CT scanning combined with serum tumor markers andcryptococcus capsule antigen in the diagnosis of malignant SPN were 83.5% and 65.7%,respectively.It can be seen that the sensitivity of the combination of the three is the highest.Conclusion 1.When the CT imaging features of pulmonary nodules are lobulation,burr,vascular entanglement sign,located in the upper lobe,diameter>8 mm,combined with the advanced age of patients and a large history of smoking,we should be highly alert to the possibility of malignant nodules.2.Thin-slice CT scanning combined with serum tumor markers and cryptococcus capsule antigen has high sensitivity and specificity in the differential diagnosis of benign and malignant SPN,which is beneficial to the early detection of malignant SPN and has a certain application value in the differential diagnosis of benign and malignant SPN,and is worth popularizing. |
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