论文部分内容阅读
目的 :研究CT扫描与肺活检后痰液脱落细胞的端粒酶活性和p16甲基化检测对早期周围型肺癌的诊断意义。方法 :用PCR TRAP ELSA半定量及PCR TRAP银染定性法、甲基化相关的PCR法 ,前瞻性检测 5 5例经CT扫描而发现的肺部孤立性结节 (直径≤ 30mm)、并疑诊为早期周围型肺癌的患者 (T1N0 M0 ) ,行CT导向肺活检 (纤维支气管镜肺活检 33例 ,经皮肺针刺活检 2 2例 )后 2 4h内痰液脱落细胞端粒酶活性及p16甲基化状态 ,并将检测结果与组织病理进行对照研究。结果 :CT扫描对周围型肺癌诊断的敏感性为 10 0 % ,但特异性只有 6 1 8% (34/ 5 5 )。端粒酶活性的敏感性为 79 4 % ,特异性为 90 5 % ,准确性为 83 6 % ;p16甲基化的敏感性为 32 4 % ,特异性为 10 0 % ,准确性为 5 8 2 % ,3者联合检测的敏感性为 86 1% ,特异性为 90 5 % ,准确性为 87 3%。对照组端粒酶阳性率 9 5 % (2 / 2 1) ,无1例检测到p16甲基化。结论 :CT扫描与端粒酶活性、p16甲基化联合可弥补痰液的细胞学检查的不足 ,提高肺癌痰检的敏感性 ,有助于周围型肺癌早期诊断和肺部孤立性结节的鉴别诊断
Objective : To study the significance of telomerase activity and p16 methylation detection of exfoliated cells in sputum after CT scan and lung biopsy for early peripheral lung cancer. METHODS: Semiquantitative PCR with TRAP ELSA and PCR TRAP silver staining qualitative and methylation-related PCR methods were used to prospectively detect 55 isolated lung nodules (diameter ≤ 30 mm) and suspected by CT scan. Patients with early-stage peripheral lung cancer (T1N0 M0) undergoing CT-guided lung biopsy (bronchoscopic lung biopsy in 33 cases, percutaneous lung acupuncture biopsy in 22 cases) within 24 hours after sputum exfoliated cell telomerase activity and The p16 methylation status was compared with histopathology. Results: The sensitivity of CT scan in the diagnosis of peripheral lung cancer was 100%, but the specificity was only 61.8% (34/55). The sensitivity of telomerase activity was 79.4%, the specificity was 90.5%, the accuracy was 83.6%; the sensitivity of p16 methylation was 32.4%, the specificity was 100%, and the accuracy was 5 8 . The sensitivity of the combined detection of 2% and 3 was 86 1%, the specificity was 90.5%, and the accuracy was 87 3%. The positive rate of telomerase in the control group was 95% (2/21), and no p16 methylation was detected in 1 case. Conclusion: CT scan combined with telomerase activity and p16 methylation can compensate for the lack of sputum cytology, increase the sensitivity of lung cancer sputum examination, and help early diagnosis of peripheral lung cancer and solitary pulmonary nodule. Differential diagnosis