| Objective:The diagnosis of local lymph node metastases in colorectal cancer with preoperative tumor markers combined with CT is compared with the results of gold standard postoperative pathological examination.To evaluate the consistency of preoperative and postoperative diagnosis and to evaluate the accuracy and clinical diagnostic value of preoperative TM combined with CT for the diagnosis of CRC local lymph node metastasis.Methods:To select 128 cases patients with CRC diagnosed with colonoscopy and pathological examination for the first time from Department of general surgery of Affiliated Hospital of Yan’an University from October 2015 to December 2017.All patients underwent routine preoperative CT examination and serum CEA,CA19-9,and CA72-4 examination and the treatment of parallel tumor radical operation.All lymph nodes cleaned during the operation sent examine in the pathology department in time.To evaluate the value of CT,three kinds of TM alone diagnosis and CT combined with TM for the diagnosis of CRC local lymph node metastasis.SPSS20.0 software was used to analyze the difference statistics.Diagnostic value is evaluated by sensitivity,specificity,and accuracy.The consistency of the diagnostic test was evaluated by Kappa analysis.The accuracy of the diagnostic test was evaluated by the area under the ROC curve.Results:1.In the period of N0,N1 and N2,the median of CEA,CA19-9 and CA72-4 is respectively 3.09 ng/L,14.38 U/mL,2.76 U/mL;4.68 ng/L,24.51 U/mL,5.36 U/mL;54.74ng/L,25.72 U/mL,5.91 U/mL.The difference of the test was statistically significant(P<0.05).That is the levels of CEA,CA19-9 and CA72-4 are not all the same in the N0,N1 and N2 stages.Analysis of differences between groups,There was a significant difference between the levels of CEA,CA19-9 and CA72-4 between the N0 and N1stages and the N0 and N2 stages(P<0.05).There is no statistical difference between N1and N2 stages(P>0.05).2.In N0,N1 and N2,the positive rates of CEA,CA19-9,CA72-4 and CT were respectively 30%,17.1%,14.3%,37%;35.5%,22.6%,25.8%,80.6%;59.3%,40.7%,37%,37%.The difference of the test was statistically significant(P<0.05).3.The postoperative pathological examination of lymph node metastasis is considered as the gold standard.The sensitivity,specificity and accuracy of CEA,CA19-9,CA72-4 and CT in the diagnosis of local lymph node metastasis were respectively 46.55%,70%,59.38%,31.03%;82.86%,59.38%,31.03%,85.71%;60.94%,81.03%,60%,60%.Combined diagnosis of CEA,CA19-9 and CA72-4 were74.13%、57.14%、64.84%,Combined diagnosis of CEA、CA19-9、CA72-4 and CT were 87.93%、58.57%、71.88%.4.The consistency of the diagnostic test was evaluated by Kappa analysis.The Kappa value is expressed in K.Comparison of CEA,CA19-9,CA72-4,CT with gold standard diagnosis respectively K were 0.17(P=0.05);0.01(P>0.05);0.18(P<0.05);0.42(P<0.05).Comparison of CEA,CA19-9,CA72-4 combined with gold standard diagnosis K were 0.31(P<0.05).Comparison of CEA,CA19-9,CA72-4 and CT combined with gold standard diagnosis K were 0.45(P<0.05).The accuracy of the diagnostic test was evaluated by the area under the receiver operating characteristic curve(A_Z).The single diagnostic of CEA,CA19-9,CA72-4 and CT A_Z were respectively 0.797,0.773,0.734 and 0.717.The combined diagnosis of CEA,CA19-9 and CA72-4 AZ was 0.858.The combined diagnosis of CEA,CA19-9 CA72-4and CT AZ was 0.858.The hypothesis test of AZ showed that P was<0.05,and the difference was statistically significant.Conclusion:1.The levels and the positive rates of serum CEA,CA19-9,and CA72-4 in patients with CRC were not the same in N0,N1 and N2 phase before operation.With the increase of N staging,there is a tendency to increase.Patients with higher levels may tend to be more late in N staging.However,the value of CRC specific N staging is limited,and can only be used for auxiliary diagnosis of preoperative CRC regional lymph node metastasis.2.Compared with the postoperative pathological diagnosis,the sensitivity and accuracy of CEA,CA19-9 and CA72-4 in the diagnosis of CRC local lymph node metastases were low.The combined diagnosis of CEA,CA19-9 and CA72-4 can improve the sensitivity and accuracy of the diagnosis.3.The positive rates of CT in patients with CRC were not the same in N0,N1 and N2 phase before operation.With the increase of N staging,there is a tendency to increase.Compared with the postoperative pathological diagnosis,the sensitivity and accuracy of CT for the diagnosis of CRC local lymph node metastasis were higher than that of TM single and combined examination results.4.Compared with CEA,CA19-9,CA72-4,CT respectively examination and CEA,CA19-9,and CA72-4 combined examination.Combined detection of CEA,CA19-9,CA72-4 and CT can improve the sensitivity and accuracy of diagnosis in the premise of ensuring that the diagnosis results are consistent with the gold standard postoperative pathological diagnosis results.That is to say,CEA,CA19-9,and CA72-4 combined CT examination can reduce the missed diagnosis of tumor patients and provide more accurate preoperative tumor staging,which has a higher diagnostic value. |
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