The Value Of Circulating Tumor Cells Combined With Chest CT In The Differential Diagnosis Of Benign And Malignant Pulmonary Nodules

Objective: The purpose of this study was to analyze the general clinical characteristics,the number of CTCs and the chest CT signs of the patients with pulmonary nodules who were operated on in cardiothoracic surgery of General Hospital of Tianjin Medical University.To explore the value of combined CTC quantity,chest CT signs and tumor markers in the differential diagnosis of benign and malignant pulmonary nodules.Methods: The subjects were SPN patients diagnosed by pathology from January 1,2019 to January 31,2020 in cardiothoracic surgery of General Hospital of Tianjin Medical University.The sex,age,smoking history,tumor family history,number of CTCs,chest CT signs(location of nodules,maximum cross-sectional diameter,edge features,internal structure features,etc.)and lung tumor markers of SPN patients were collected.According to the different pathological results of SPN,it can be divided into malignant nodule group and benign nodule group.In the two groups,sex,age,smoking history,tumor family history,number of CTC,chest CT signs,lung tumor markers and other aspects were statistically analyzed.To analyze the relationship between the number of CTCs and the clinical and pathological characteristics of SPN patients.The results of SPN were predicted by the mathematical model of SPN benign and malignant prediction established by the thoracic surgery department of the First Affiliated Hospital of Guangzhou Medical University.The ROC curve was drawn to reflect the accuracy of combined CTC quantity,chest CT signs and tumor markers in the diagnosis of pulmonary nodules.Results: In this study,51 cases were collected,38 cases in malignant nodule group and 13 cases in benign nodule group.The age of patients with benign and malignant nodule was 53.85±14.43 and 63.39±7.07 years,respectively,which indicated that the average age of patients in malignant nodule group is older(P<0.05),but there is no significant difference in gender,smoking history and tumor family history between the two groups(P>0.05).The diameter of pulmonary nodule is 13.08±6.10 mm and 18.45±5.32 mm,the ratio of vascular cluster sign was 23.08% and 63.16%,the ratio of lobular sign is 15.38% and 68.42%,the ratio of marginal fuzzy sign is 23.08% and 65.79%,and the ratio of burr sign was 38.46% and 71.05%,respectively,indicating that the diameter of malignant pulmonary nodule is larger,and there are vascular cluster sign,lobular sign and marginal model(P<0.05).The two groups of patients had no statistically significant differences in nodule location and chest CT signs(pleural pit sign,vacuole sign,calcification,bronchial inflation sign)(P>0.05).The levels of CEA in patients with benign and malignant nodules are 3.026±1.786,4.746±4.087 ng/ml,and the levels of CYFRA21-1 are 2.488±0.514,3.372±1.410 ng/ml,it shows that the levels of CEA and CYFRA21-1 in the malignant nodule group are higher than those in the benign nodule group,and the difference between benign and malignant lung nodules is statistically significant(P<0.05);while the NSE and SCC levels of the two groups are no statistically significant(P>0.05).The difference in the number of CTCs between benign and malignant lung nodules is statistically significant(P<0.05);the difference in the number of CTCs between different sizes of lung nodules and the TNM staging of different lung cancers is statistically significant.The larger the diameter,the later the stage,the larger the number of CTCs(P<0.05);the number of CTCs in different pathological types of lung cancer patients is not statistically significant(P>0.05);according to the prediction results of the SPN benign and malignant prediction mathematical model,the prediction results of the number of CTCs,the combined prediction results of the two ROC curve,AUC were 0.830±0.077,0.674±0.085,0.907±0.074.Conclusions: 1.The differences of patient age,pulmonary nodule diameter,chest CT signs(vascular bundle sign,lobulated sign,margin,burr sign),serum CEA,CYFRA21-1 in benign and malignant lung nodules are statistically significant.2.The difference in the number of CTCs between lung nodules of different sizes and the TNM stages of different lung cancers was statistically significant.The difference in the number of CTCs in different pathological types of lung cancer was not statistically significant.3.Combined chest CT signs,number of CTCs and tumor markers can improve the accuracy of the differential diagnosis of lung nodule properties,and contribute to the early diagnosis of clinical lung cancer.