Hong Su Jin, Kim Tae Jung, Lee Jae-Ho, Park Jeong-Soo
aDepartment of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do bDepartment of Radiology, Hallym University Kangdong Sacred Heart Hospital cDepartment of Radiology, Samsung Medical Center, Gangnam-gu, Seoul dDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do eDepartment of Biochemistry, College of Medicine, Dankook University, Cheonan, Korea.
Medicine (Baltimore). 2016 Jun;95(26):e3978. doi: 10.1097/MD.0000000000003978.
To describe the features and clinical implications of computed tomography (CT), positron emission tomography (PET), and percutaneous needle aspiration biopsy (PCNB) in pulmonary nontuberculous mycobacterial (NTM) disease manifesting as a solitary nodule, mass, or mass-like consolidation mimicking malignancy.Among a cohort of 388 patients with NTM pulmonary disease, 14 patients with clinically and radiologically suspected lung cancer were included in our study. Two chest radiologists evaluated CT features, including lesion type (nodule, mass, or mass-like consolidation), morphologic features (margin, degree of enhancement, calcification), and presence of accompanying findings suggestive of NTM pulmonary disease (bronchiectasis with clustered centrilobular nodules or upper-lobe cavitary lesions) by consensus. Diagnostic procedures for microbiologic diagnosis of NTM disease and clinical outcome were reviewed.Incidence of NTM pulmonary disease presenting as solitary nodule/mass (n = 8) or mass-like consolidation (n = 6) was 3.6% (14 of 388). Most lesions were detected incidentally during routine health check-up or evaluation of other disease (11 of 14, 79%). Lesions typically showed poor contrast-enhancement (9 of 12) and internal calcification (6 of 14). No lesions had CT features suggestive of NTM pulmonary disease. All 4 lesions for which PET/CT imaging was performed showed strong fluorodeoxyglucose uptake simulating malignant lesions (mean, 4.9; range, 3.6-7.8). PCNB revealed mycobacterial histology in 6 of 11 specimens and positive culture results were obtained for 7 of 7 specimens.NTM pulmonary disease may present as a solitary nodule, mass, or mass-like consolidation mimicking malignancy. CT features and PCNB are important to diagnose NTM disease mimicking lung cancer to avoid unnecessary surgery.
描述计算机断层扫描（CT）、正电子发射断层扫描（PET）和经皮针吸活检（PCNB）在表现为孤立性结节、肿块或类似肿块的实变影且疑似恶性肿瘤的肺非结核分枝杆菌（NTM）病中的特征及临床意义。在388例NTM肺病患者队列中，14例临床及影像学疑似肺癌的患者纳入本研究。两名胸部放射科医生通过共识评估CT特征，包括病变类型（结节、肿块或类似肿块的实变影）、形态学特征（边缘、强化程度、钙化）以及提示NTM肺病的伴随表现（伴有簇状小叶中心结节的支气管扩张或上叶空洞性病变）。回顾NTM病的微生物学诊断程序及临床结局。表现为孤立性结节/肿块（n = 8）或类似肿块的实变影（n = 6）的NTM肺病发生率为3.6%（388例中的14例）。大多数病变在常规健康检查或其他疾病评估期间偶然发现（14例中的11例，79%）。病变通常表现为强化不佳（12例中的9例）及内部钙化（14例中的6例）。无病变具有提示NTM肺病的CT特征。进行PET/CT成像的4例病变均显示强烈的氟脱氧葡萄糖摄取，类似恶性病变（平均值为4.9；范围为3.6 - 7.8）。11例标本中有6例PCNB显示分枝杆菌组织学，7例标本中有7例培养结果为阳性。NTM肺病可能表现为孤立性结节、肿块或类似肿块的实变影，疑似恶性肿瘤。CT特征及PCNB对于诊断疑似肺癌的NTM病以避免不必要的手术很重要。
