Singh Vikas Kumar, Chandra Subhash, Kumar Sachin, Pangtey Ghanshyam, Mohan Anant, Guleria Randeep
Department of Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Asian Pac J Cancer Prev. 2009 Jul-Sep;10(3):335-8.
To emphasize that delay in diagnosis of lung cancer can be caused by the wrong diagnosis of tuberculosis (TB) in TB endemic countries. This is of major concern as early-diagnosis of lung cancer can increase the chance of tumor resectability and timely chemo-radiotherapy may provide better quality of life.
Proven lung cancer patients, who had received anti-tubercular treatment (ATT) since onset of current symptoms, were studied retrospectively during the period of Nov-07 to Nov-08. DATA-SOURCE: Patient interview and medical records.
Total of 14 out of 70 patients received wrong diagnosis of TB and had received ATT (male-12, female-2; mean age 58.07-/+6.81; Non Small Cell Lung Cancer (NSCLC) -12, Small Cell Lung Cancer (SCLC) -2), 12 were smokers with median smoking pack-years of 44(15 to 112). Pre-referral sputum acid fast bacilli (AFB) was done in only 3 out of these 14 patients and sputum AFB was negative in these 3 patients. ATT was started on the basis of chest X-ray finding and clinical symptoms. Mean duration of ATT taken was 4.46-/+3.15 months.
Due to high TB prevalence and radiological similarities, a large number of lung cancer patients initially get wrongly treated for TB. Also, clinicians associate lung cancer with high case-fatality and start ATT without detailed investigation. Altogether, this leads to delay in diagnosis and progression of disease.
强调在结核病流行国家，肺癌诊断延迟可能是由于对结核病（TB）的误诊所致。这是一个主要问题，因为肺癌的早期诊断可增加肿瘤可切除性的机会，及时的放化疗可能会提供更好的生活质量。
对自出现当前症状以来接受抗结核治疗（ATT）的确诊肺癌患者进行回顾性研究，研究时间为2007年11月至2008年11月。数据来源：患者访谈和病历。
70例患者中有14例被误诊为结核病并接受了抗结核治疗（男性12例，女性2例；平均年龄58.07±6.81岁；非小细胞肺癌（NSCLC）12例，小细胞肺癌（SCLC）2例），12例为吸烟者，中位吸烟包年数为44（15至112）。在这14例患者中，只有3例在转诊前进行了痰涂片抗酸杆菌（AFB）检查，这3例患者的痰涂片AFB均为阴性。抗结核治疗是根据胸部X线检查结果和临床症状开始的。抗结核治疗的平均持续时间为4.46±3.15个月。
由于结核病患病率高且影像学表现相似，大量肺癌患者最初被误诊为结核病并接受治疗。此外，临床医生将肺癌与高病死率联系起来，在没有详细调查的情况下就开始抗结核治疗。总之，这导致了疾病诊断的延迟和病情进展。
