| ObjectiveIn the past years, the morbidity and mortality of primary bronchogenic carcinoma (lung cancer, LC) have risen rapidly. Now LC has turned to be the highest prevalent cancer in the world,so it has seriously influenced publilc health. In China, LC is also one of the highest deathful malignant tumors. Among all the tumors, mortality rate of LC is the first in cities and the forth in the countryside. The patients with lung cancer become increasingly younger. Therefore, the early diagnosis and the treatment of lung cancer appear to be much significant. Researches about the serum tumor marker(TM) are a substaintial aspect of modern oncology. The major tumor markers of lung cancer include carcinoembryonic antigen, Cytokeratin Fragment Atigen21-1 and neuron-specific enolase. Their serum levels of LC patients are useful to screening, diagnosis, prognosis and turnover of the lung cancer. However, detection of single tumor marker lacks sensitivity and specificity. So, in our study, we detect the LC patients'serum levels of all the there above major lung tumor markers, carcinoembryonic antigen (CEA), Cytokeratin Fragment Atigen21-1 (CYFRA21-1) and Neuron-specific enolase (NSE). According to pathology through percutaneous CT-guided lung biopsy and LC patients'serum levels of the above lung tumor markers, we can preliminarily evaluate their clinical value for diagnosis of lung cancer.CT-guided percutaneous lung biopsy is an effective method to diagnose and identify space-occupying diseases of lung. Combining with modern medical imaging technology, pathology and cytology, it can obtain the pathological samples of lung tissue to diagnose lung diseases, thus we can quickly determine the concrete treatment. This method has many advantages including higher precision, less invasive injury, slight pain and fewer complications that it is of great clinical value especially in the diagnosis of the peripheral LC or other lung tumors. In this study, we explore the clinical value of the lung tumor markers (CEA, CYFRA21-1 and NSE) and CT-guided percutaneous lung biopsy for diagnosis of lung cancer, and investigate the complications, risk factors, prevention and cure measures after CT-guided percutaneous lung biopsy.14 examples had not obtained the correct diagnosis, the accuracy was 95.95%(332/346).Material and methodsClinical dataIn our study, all clinical data apply a retrospective analysis. During Nov.2008-Nov.2010,346 patients(men,225 and women,121), aging 14y-86y, mean age (57±11)y, They were all performed CT-guided percutaneous lung biopsy (FX/I spiral CT machines, GE company and Biopsy gun automatic biopsy needle, Bard, American).Progress of the CT-guided percutaneous lung biopsyAll patients were administrated routine CT scanning pre-operation. Some patients were administrated chest CT scanning or MRI to understand blood supply of the lesions and observe the relationship between the lesions and lung large vessels. Before CT scanning, we utilized Catheter Rack to make skin surface positioning mark. Firstly, we chose best biopsy level according to previously CT or MRI. According to the best biopsy level, we measured the shortest distance between puncture point and lesion. We identified the skin surface positioning mark corresponding to pulmonary lesions according to CT cursor and skin surface positioning mark by catheter rack. We measured and simulated puncture needle pathway through CT images(including direction, angle and depth of the puncture needle). After puncture needle sticked into the chest(avoiding pleural injury), we properly adjusted the direction and angle of the puncture needle through CT-guiding. When puncture needle reached the target tissues, we drew the lesion tissue. The frequency of tissue drawing depends on the condition of the target tissue and tolerance of patients.Specimen collectionTo detect the three serum tumor markers,3 ml patients' peripheral venous blood were obtained at room temperature, on an empty stomach, natural solidification. The specimens were centrifuged at once and the serum was collected and analyzed for serum levels of the CEA,CYFRA21-1,NSE.Analysis of CEA, CYFRA21-1 and NSESerum level of CEA, CYFRA21-1 and NSE were detected by ECLIA (elctrochemiluminescence immuno-assay), according to manufacturer's instructions. Serum level of CEA, CYFRA 21-1 and NSE respectively exceeding 5.0μg/L,3.3μig/L and 15.0μg/L are positive.Statistical analysisThe data were presented as Mean+SD. The results were analyzed by SPSS13.0 software. Sample mean between the two groups using independent sample t test or fisher exact test analysis. A P value less than 0.05 was considered to indicate a significant difference.ResultsCT-guided percutaneous lung biopsy132 samples biopsy were benign lesions (64 samples were pneumonia,40 samples were tuberculosis,12 samples were inflammatory pseudotumor,3 samples were benign tumor,3 samples were granulomatous inflammation, one samples were pneumoconiosis,9 samples were lung tissue or necrotic tissue).214 samples were malignant lesions (128 samples were adenocarcinoma,43 samples were squamous cell carcinoma,14 samples were small cell carcinoma,11 samples were metastatic carcinoma). Among all the 346 patients, we failed to get the pathological samples of 6 patients at the first time, but gained satisfaction samples at the second time,2 samples were squamous cell carcinoma,2 samples were adenocarcinoma, the others were pneumonia.Postoperative complicationsAmong the 346 patients,73 patients were with complications altogether. Including 45 pneumothorax (13.01%),31 bleeding (8.96%), five subcutaneous emphysema examples. No patient presented air embolism, cardiac tamponade and the tumor spreads or die. In 45 pneumothoraxes cases,38 mild pneumatothorax(84.44%), three moderate pneumatothorax (6.67%), fore serious pneumatothorax (8.89%). Tow moderate pneumothorax patients got better after thoracentesis, tow moderate pneumothorax patients got better after thoracic close drainage.31 bleeding patients after paracentesis, (8 hemoptysis,26 errhysis of puncture pathway,3 hemothorax),20 mild bleeding (65.52%), eight moderate bleeding (25.81%), three serious bleeding (9.68%). Tow patients of the serious bleeding got better after expectant treatment, one patient presented hemothoraxes postoperatively and got better after pulmonary lobectomy.The relationship between complications and size of the lesionThe bleeding incidences of lesion<3cm are significantly higher than that≥3cm(P<0.05);The relationship between complications and lesion locationThe pneumothorax and bleeding incidences of lesion<2cm to the thoracic wall are lower than that of lesion≥2cm to the thoracic wall. (P<0.05);The value of tumor markers in diagnosis of lung cancer and benign lung diseaseThe lung cancer group serum levels of CEA, CYFRA21-1, NSE are significantly higher than that of the benign lung disease group (P<0.05);Comparison of Serum CEA, CYFRA21-1, NSE levels between different pathological types of lung cancerThe small cell lung cancer patients'positive rate of NSE was significantly higher than that of non-small cell lung cancer (P<0.05).Conclusions1. CT-guided percutaneous lung biopsy is of great clinical value for the diagnosis of lung cancer;2. CT-guided percutaneous lung biopsy has many advantages, including higher safety, minimally invasive injury and less complications. For diagnosing benign and malignant lesions of the lung, CT-guided percutaneous lung biopsy appears to be better accurate;3. The CEA, CYFRA21-1, NSE serum levels of patients with lung cancer are significantly higher than that of patients with benign lung disease group (P<0.05). The positive rate of NSE of patients with small cell lung carcinoma group was higher than that of patients with non-small cell lung cancer group(P<0.05).4. Combining detection of lung tumor markers(CEA, CYFRA21-1 and NSE) can improve the sensitivity and accuracy of lung cancer, conduce to the early diagnosis of lung cancer.5. In lungs benign disease group, a few patients'serum levels of CEA, CYFRA21-1, NSE exceed scope of positive rate, especially the patients with the chronic blocking pulmonary tuberculosis and the multi-lobes of the lung, wide range lungs infectious disease. Weather these serum levels can be applied to predict trend of tumorigenesis that necessitate further researches to acknowledge. That need patient to follow-up, and regular review.6. Combining detection of lung tumor markers (CEA, CYFRA21-1 and NSE) and CT-guided percutaneous lung biopsy can extensively enhance diagnostic accuracy of lungs tumor. This method is significant and can be widely used in clinical application. |
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