The Study Of Correlation Of CT Features, Pathology And Ki-67, P53 , Serum Tumor Markers In Peripheral Lung Cancer

Part I. The study of correlation of CT features, pathology and Ki-67, p53 expression in peripheral lung cancer1. Objective: To study the correlation of CT features, pathology and Ki-67, p53 expression in peripheral lung cancer.2. Materials and Methods:(1) Collected 53 cases of peripheral lung cancer confirmed by operation and pathology from January 2008 to August 2009. 35 cases were male and 18 cases were female, the oldest was 81 years and the youngest was 33 years old, the average age was (59±13) years old.34 cases were adenocarcinoma (3 cases poorly differentiated, 1 case moderately~poorly differentiated, 19 cases moderately differentiated, 2 cases moderatly~well differentiated, 9 cases well differentiated) , 12 cases were squamous carcinoma (6 cases poorly differentiated, 1 case moderately~poorly differentiated, 3 cases moderately differentiated, 1 case moderatly~well differentiated, 1 case well differentiated) , 3 cases were adenosquamous carcinoma (2 cases moderately~poorly differentiated, 1 case moderately differentiated) , 3 cases were small-cell lung cancer (3 cases poorly differentiated) , 1 case large cell carcinoma(1 case poorly differentiated). The main clinical symptoms: cough, hemoptysis, shortness of breath, chest pain, chest tightness, fever, weight loss and so on.(2) Plain and enhanced scan used 16-slice spiral CT Somatom Sensation from German Siemens company.Subjects in supine position, head to foot direction.The whole lung was scaned from apex to the diaphragm.Enhanced scan after injection of contrast agent from the beginning 28 seconds. Contrast agent was non-ionic contrast agent ultravist (300mg/ml), used syringes single-phase high pressure injection, which injection rate was 3.6 ml/s.The amount of contrast agent was caculated by weight 1.5 ml/kg.(3) The measurement of increased CT value in lung lesions:The enhanced CT value subtract the plain CT value was the increased CT value.Plain and enhanced slices of measurement range as consistent as possible. ROI was in the central district and the measurement range occupied 70% or more of the short diameter in the lesion , besides,all measured should avoid affects of calcification and volume effect.Took the average CT value of 3 slices in the lesion as the CT value of that phase.(4) Immunohistochemical detect methods and results determined:Reagent:The first antibody were Ki-67 clone No:MIB-1 and p53 clone No:D0-7. The second antibody was quick-to-use immunohistochemical EnVision detection kit.DAB Color liquid, Citric acid buffer and PBS liquid.All of the above were from Dako company. Detection step:Used EnVision two-step method to detect the expression of Ki-67 and p53.Detailed steps were carried out in strict accordance with the instructions. Results determined: Ki-67 and p53 express in the nucleus,showed brown particles.Each slice was observed in 10 high magnification field, and calculated the number of positive cells.Ki-67 antigen expression was indicated with percentage of positive cells. p53 expression was indicated with: <10% is"-",10%～50% is"+",>50% is"++".3. Results: The percentage of Ki-67 antigen in squamous carcinoma was significantly higher than that in adenocarcinoma. The percentage of Ki-67 antigen in 34 cases with adenocarcinoma was (17.71±16.72)%, while in 12 cases with squamous carcinoma was (38.88±25.84)%. The p53 expression showed no relation with the histopathological type in lung cancer. There was negative correlation of the Ki-67 antigen, p53 expression and the tumor differentiation degree in lung cancer. The correlation coefficient was r=-0.599 and r=-0.507 respectively. Lesions with deep lobulation sign, spiculation sign,spinous protuberant sign, tumor diameter≥3cm,increased CT value≥20Hu or lymph node enlargement of hilar or mediastinal ,their Ki-67 antigen and p53 expression were higher. Lesions with vacuole sign or ground-glass opacity,their Ki-67 antigen expression were lower, though it showed no significant relation with the p53 expression. Lesions with pleural indentation sign, air-bronchogram sign, cavity or calcification showed no significant relation with the Ki-67 antigen and p53 expression. The percentage of Ki-67 antigen in p53 positive group was higher than that in the negative group.23 cases whose p53 were negative,their average percentage of Ki-67 antigen was (19.41±19.61)%.30 cases whose p53 were positive,their average percentage of Ki-67 antigen was (32.90±24.09)%.4. Conclusion: In the CT features of peripheral lung cancer, deep lobulation sign, spiculation sign,spinous protuberant sign, tumor diameter≥3cm,increased CT value≥20Hu, vacuole sign, ground-glass opacity or lymph node enlargement of hilar or mediastinal could reflect the Ki-67 antigen and p53 expression in the tumor to some extent. The combination of CT features and the Ki-67 antigen, p53 expression of the tumor ,could help to estimate the degree of proliferative activity. Part II. The study of correlation of CT features, pathology and the concentration of serum tumor markers in peripheral lung cancer1. Objective: To study the correlation of CT features, pathology and the concentration of serum tumor markers CEA, CYFRA21-1, SCC-Ag, NSE, CA50 in peripheral lung cancer.2. Materials and Methods:(1) Collected 48 cases of peripheral lung cancer confirmed by operation and pathology from January 2008 to August 2009. 32 cases were male and 16 cases were female, the oldest was 81 years and the youngest was 33 years old, the average age was (56±12) years old.30 cases were adenocarcinoma (2 cases poorly differentiated, 1 case moderately~poorly differentiated, 16 cases moderately differentiated, 2 cases moderatly~well differentiated, 9 cases well differentiated) , 11 cases were squamous carcinoma (5 cases poorly differentiated, 1 case moderately~poorly differentiated, 3 cases moderately differentiated, 1 case moderatly~well differentiated, 1 case well differentiated) , 3 cases were adenosquamous carcinoma (2 cases moderately~poorly differentiated, 1 case moderately differentiated) , 3 cases were small-cell lung cancer (3 cases poorly differentiated) , 1 case large cell carcinoma(1 case poorly differentiated). The main clinical symptoms: cough, hemoptysis, shortness of breath, chest pain, chest tightness, fever, weight loss and so on.(2) Plain and enhanced scan used 16-slice spiral CT Somatom Sensation from German Siemens company.Subjects in supine position, head to foot direction.The whole lung was scaned from apex to the diaphragm.Enhanced scan after injection of contrast agent from the beginning 28 seconds. Contrast agent was non-ionic contrast agent ultravist (300mg/ml), used syringes single-phase high pressure injection, which injection rate was 3.6 ml/s.The amount of contrast agent was caculated by weight 1.5 ml/kg.(3) The measurement of increased CT value in lung lesions:The enhanced CT value subtract the plain CT value was the increased CT value.Plain and enhanced slices of measurement range as consistent as possible. ROI was in the central district and the measurement range occupied 70% or more of the short diameter in the lesion , besides,all measured should avoid affects of calcification and volume effect.Took the average CT value of 3 slices in the lesion as the CT value of that phase.(4) Detection methods of serum tumor markers: Reagent: CEA, CYFRA21-1, SCC-Ag and NSE from Roche company.CA50 from Tianjin Xiehe Medical Technology company. Detection step:The detection of CEA and SCC-Ag used ECLIA by Abbott I-2000 from America. The detection of CYFRA21-1 and NSE used ECLIA by Cobas e411. The detection of CA50 used RIA. Detailed steps were carried out in strict accordance with the instructions. Results determined: Reference value: CEA 0~10 ng/ml,CYFRA21-1 0~3.6 ng/ml,SCC-Ag 0~1.5 ng/ml,NSE 0~15 ng/ml,CA50 0~25 U/ml.3. Results: The serum CEA concentration in adenocarcinoma was higher than that in squamous carcinoma. The serum CYFRA21-1,SCC-Ag concentration in squamous carcinoma was higher than that in adenocarcinoma. Serum CEA, CYFRA21-1,SCC-Ag concentration in 30 cases adenocarcinoma was (13.23±20.47)ng/ml, (5.26±4.14)ng/ml and (1.04±0.75)ng/ml respectively. Serum CEA, CYFRA21-1, SCC-Ag concentration in 11 cases squamous carcinoma was (3.62±2.48)ng/ml,(8.70±3.27)ng/ml and (5.57±5.39)ng/ml respectively. There was no correlation of the serum CEA,CYFRA21-1,SCC-Ag,NSE,CA50 concentration and the tumor differentiation degree in lung cancer. The concentration of serum tumor markers CEA,NSE were higher in lung lesions with deep lobulation sign. The concentration of serum tumor markers CEA,CYFRA21-1,NSE were higher in lung lesions which diameter was≥3cm. The concentration of serum tumor markers CYFRA21-1 was higher in lung lesions with cavity. The concentration of serum tumor markers SCC-Ag was lower in lung lesions with vacuole sign or ground-glass opacity. There was no relation of lung lesions with pleural indentation sign, spiculation sign,spinous protuberant sign, increased CT value≥20Hu, calcification or lymph node enlargement of hilar or mediastinal and their serum tumor markers concentration. There was positive correlation of the percentage of Ki-67 antigen and the serum CEA concentration in lung cancer. The correlation coefficient was r=0.576. The serum CEA concentration in p53 positive group was higher than that in the negative group. 22 cases whose p53 were negative,their average serum CEA concentration was (3.64±2.11)%.26 cases whose p53 were positive,their average serum CEA concentration was (19.37±24.40)%.4. Conclusion:(1) Peripheral lung cancer with deep lobulation sign, its serum CEA and NSE concentration were higher. Tumor diameter≥3cm, its serum CEA, CYFRA21-1, NSE concentration were higher.Lung cancer with cavity,its serum CYFRA21-1 concentration was higher. Lung cancer with vacuole sign or ground-glass opacity,its serum SCC-Ag concentration was lower.There was no significant difference of CT features in peripheral lung cancer and serum CA50 concentration.(2) There was positive correlation of serum CEA concentration and the expression of Ki-67 antigen. The serum CEA concentration in p53 positive group was higher.