Efficacy Of Contrast-enhanced Ultrasound Combined With Serum Lung Tumor Markers In The Diagnosis Of Peripheral Pulmonary Lesions

Objective: Based on percutaneous lung biopsy,this paper discusses the qualitative diagnostic value of conventional ultrasound and contrast-enhanced ultrasound combined with serum lung tumor markers in peripheral pulmonary lesions,analyzes the characteristics of conventional ultrasound and contrast-enhanced ultrasound of peripheral pulmonary lesions,quantitatively analyzes the contrast parameters,and obtains the best cut-off value of malignant lesions.Combined with serum lung tumor markers to improve the diagnostic efficiency of peripheral pulmonary lesions.Materials and methods: Patients with peripheral pulmonary lesions found by chest CT and displayed by ultrasound in the Affiliated Hospital of Yan’an University from October 2019 to February 2022 were selected as the research objects.Ultrasound-guided percutaneous lung biopsy was performed to determine the histopathology results.The patients were divided into experimental group(contrast-enhanced ultrasound group)and control group(conventional ultrasound group)according to whether contrast-enhanced ultrasound examination was performed before puncture.The puncture success rate and complication rate of the two groups were compared,and the characteristics and parameters of conventional ultrasound and contrast-enhanced ultrasound were recorded.The patients were divided into benign group and malignant group according to the pathological results,and the morphology,location,size,blood flow signal and air bronchial sign of all lesions were analyzed.The enhancement degree,enhancement homogeneity,necrosis and vascular signs of the lesions in the contrast group were analyzed;Quantitative analysis of parameters such as lesion contrast agent Arrival time(AT),inflatable lung tissue contrast agent arrival time(L-AT),chest wall contrast agent arrival time(W-AT),lesion inflatable lung tissue contrast agent arrival time difference(D1-AT),chest wall lesion contrast agent arrival time difference(D2-AT),peak time(TTP),enhancement degree(PI)and rising slope(AS);The differences of serum lung tumor markers neuron specific enolase(NSE),carcinoembryonic antigen(CEA),Cytokeratin-19-fragment(CYFRA21-1)and carbohydrate antigen 125(CA125)in benign and malignant lesions were analyzed;Combined with quantitative parameters of contrast-enhanced ultrasound to study its diagnostic efficacy and correlation.Results: 1.There was no significant difference in demographic characteristics,age and gender of patients in this study(Z=-1.564,P =0.118;χ~2=1.053,P=0.305),there was no significant difference in the location of lesions between conventional ultrasound features(χ~2=0.167,P=0.683),there were significant differences in the maximum diameter,shape,blood flow signal and air bronchial sign(P<0.05).2.The incidence of complications in contrast-enhanced ultrasound group and conventional ultrasound group were 7.7% respectively 14%(4/56)and 5%(1/20),there was no significant difference between the groups(χ~2= 0.110,P=1.000).The puncture success rate of contrast-enhanced ultrasound group was 100%(56/56),and that of conventional ultrasound group was 85%(17/20).The difference between the groups was statistically significant(χ~2= 8.745,P=0.016).A total of 58 patients underwent contrast-enhanced ultrasound,excluding 2 patients without biopsy,a total of 56 patients were included.The results showed that the qualitative index items of contrast-enhanced ultrasound had statistically significant differences between benign and malignant groups in terms of lesion enhancement,necrosis and internal vascular signs(χ~2=6.487,P=0.035;χ~2=4.156,P=0.041;χ~2=11.710,P=0.001),there was no significant difference between the groups in terms of lesion enhancement homogeneity(χ~2=3.733,P=0.053).The quantitative parameters of contrast-enhanced ultrasound AT,D1-AT,D2-AT,TTP and PI were significantly different between benign and malignant groups of peripheral pulmonary lesions(P＜0.05),but there was no significant difference among L-AT,W-AT and as groups(P >0.05).Comparing the area under the curve of AT,D1-AT,D2-AT,TTP and PI,it is concluded that there is no significant difference in the diagnostic value of the five parameters in peripheral pulmonary malignant lesions.There was significant difference in AUC between AT > 8.66 s and AT > 10 s,and there was no significant difference among other groups3.There were significant differences in the contents of serum lung tumor markers CEA,NSE,CYFRA21-1 and CA125 between benign and malignant groups(Z =-3.577;Z =-3.862;Z =-5.408;Z =-2.566,all P＜0.05).The quantitative parameters of contrast AT and D1-AT were combined with the serum lung tumor marker CYFRA21-1.The three combinations were valuable in the diagnosis of malignant lesions,and the AUC was respectively 0.866 、 0.844 、 0.772,all AUC >0.5.After the combination of AT and CYFRA21-1,the area under the curve is the largest,and the sensitivity and NPV are the highest,which are 87.5% and 75.0%respectively.The specificity of D1-AT combined with CYFRA21-1 was100%.TTP was significantly correlated with CYFRA21-1(r=0.537),PI,at was significantly correlated with CEA(r=-0.534,r=0.567),and d2-at was low correlated with CEA(r=-0.418).Conclusion: 1.Conventional ultrasound is valuable in diagnosing benign and malignant peripheral pulmonary lesions.2.Contrast-enhanced ultrasound-guided percutaneous lung biopsy has higher success rate than conventional ultrasound;The qualitative and quantitative parameters of contrast-enhanced ultrasound provide a basis for the differential diagnosis of benign and malignant peripheral pulmonary lesions.3.Serum lung tumor markers have clinical value in the differential diagnosis of peripheral pulmonary lesions.Combined with contrast-enhanced ultrasound can further improve its value in the differential diagnosis of benign and malignant peripheral pulmonary lesions.The quantitative parameters of contrast-enhanced ultrasound were correlated with some serum lung tumor markers.