Application of SPECT/CT tomographic fusion imaging combined with serum CEA and CYFRA21-1 in the diagnosis of bone metastasis of non-small cell lung cancer

Abstract

Objective This study aims to study the role of SPECT/CT tomographic fusion imaging in combination with serum tumor markers such as CEA and CYFRA21-1 to diagnose bone metastasis of NSCLC. Methods A total of 143 patients with pathologically confirmed NSCLC were selected as study subjects(adenocarcinoma 88 cases, squamous cell 55 cases). Venous blood samples were collected to determine the serum levels of CEA and CYFRA21-1, and a whole body bone scan and SPECT/CT tomographic fusion imaging was performed. SPSS 22.0 software was used to compare serum CEA with CYFRA21-1 with the Mann-Whitney U rank sum test. Spearman correlation analysis was used to correlate serum CEA and CYFRA21-1 levels with the number of bone metastases. Sensitivity, specificity, and accuracy in the diagnosis of bone metastases were needed to detect the incidence of bone metastases in lung adenocarcinoma and squamous cell carcinoma of the lung via whole-body bone imaging and SPECT/CT fusion imaging with serum and serum CEA and CYFRA21-1(alone or in combination with the χ2 test). Results 68 patients demonstrated bone metastasis with a total of 586 lesions. The incidence of bone metastasis of adenocarcinoma(50/88) was higher than that of squamous cell carcinoma(18/55)(χ2=10.56, P 0.05), but there was a certain correlation between CYFRA21-1 and the number of bone metastases(r=0.502, P<0.01). Serum CEA and CYFRA21-1 levels were sensitive in the diagnosis of NSCLC bone metastasis(69.1%, 83.8%), but had low specificity(47.6%, 49.3%) and accuracy(57.3%, 65.7%) was low. The SPECT/CT tomographic fusion imaging in the diagnosis of NSCLC bone metastasis had high sensitivity(83.8%), specificity(84.0%), and accuracy(83.9%) were higher than serum CEA(χ2=4.09、23.08、24.33, all P<0.05), specificity and accuracy were higher than CYFRA21-1 (χ2=20.28、12.55, both P<0.05) and whole body bone scan(χ2=21.66、16.05, both P<0.05). The sensitivity(97.0%), specificity(93.3%), and accuracy(95.1%) of SPECT/CT tomographic fusion imaging combined with serum CEA and CYFRA21-1 in the diagnosis of NSCLC bone metastasis were higher than those of whole body bone scan(χ2=12.55、37.17、47.45, all P<0.05), serum CEA(χ2=18.89、38.89、24.33, all P<0.05), CYFRA21-1 (χ2=6.89、35.50、39.17, all P<0.05), sensitivity and accuracy were higher than SPECT/CT tomographic fusion imaging(χ2=6.89、9.53, both P<0.05) applied individually. Conclusions SPECT/CT tomographic fusion imaging combined with serum CEA and CYFRA21-1 diagnosis of NSCLC bone metastases had clinical value because of high sensitivity, specificity, and accuracy. Key words: Carcinoma, non-small-cell lung; Neoplasm metastasis; Single photon emission computed tomography computed tomography; Carcinoembryonic antigen; Cytokeratin-19-fragment