Lang Shan, Sun Junping, Wang Xuning, Xiao Yongjiu, Wang Juan, Zhang Mingyue, Ao Ting, Wang Jianxin
Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing 100853, P.R. China.
Department of Surgical Oncology, Chinese PLA General Hospital, Beijing 100853, P.R. China.
Exp Ther Med. 2017 Sep;14(3):2180-2188. doi: 10.3892/etm.2017.4737. Epub 2017 Jul 9.
Asymptomatic pulmonary tuberculosis (PTB) mimicking lung cancer is rare and has been documented in few studies. Accurately diagnosing this atypical disease remains an enormous challenge for clinicians. The aim of the present study was to characterize asymptomatic patients with PTB who were initially diagnosed with lung cancer according to their chest computer tomography (CT) or whole-body 18F-fludeoxyglucose-positron emission tomography-computer tomography (PET-CT) presentations. The clinical characteristics and radiographic features of patients with PTB were analyzed and compared to those of patients with lung cancer. In patients with PTB, all lesions exhibited suspected malignant signs on chest CT and the maximum standard uptake value (SUV) of PET-CT imaging was between 2.65 and 10.9. Compared with lung cancer, the factors associated with PTB included an age <60 years (82% vs. 46%, P=0.03), being male (77% vs. 51%, P=0.025), the presence of diabetes (55% vs. 16%, P<0.01), spiculated margins (82% vs. 44%, P=0.002) and a lower SUV (P=0.036). The optimal cut-off level was SUV 8.45 for discriminating between PTB and lung cancer. At this point, the sensitivity and specificity were 63.0 and 88.9%, respectively. The results of the current study revealed methods of distinguishing between the two similar diseases. Furthermore, the results of the current study may increase awareness that although imaging of lesions may resemble lung cancer, a diagnosis of PTB should be considered. Accurate diagnosis of PTB would mean that patients would be able to avoid undergoing unnecessary operations that induce a high financial burden.
无症状肺结核（PTB）酷似肺癌的情况罕见，仅有少数研究报道过。准确诊断这种非典型疾病对临床医生来说仍是巨大挑战。本研究旨在根据胸部计算机断层扫描（CT）或全身18F-氟脱氧葡萄糖-正电子发射断层扫描-计算机断层扫描（PET-CT）表现，对最初被诊断为肺癌的无症状PTB患者进行特征描述。分析并比较PTB患者与肺癌患者的临床特征和影像学特征。PTB患者的所有病变在胸部CT上均表现出疑似恶性征象，PET-CT成像的最大标准摄取值（SUV）在2.65至10.9之间。与肺癌相比，与PTB相关的因素包括年龄<60岁（82%对46%，P = 0.03）、男性（77%对51%，P = 0.025）、糖尿病的存在（55%对16%，P<0.01）、边缘毛刺征（82%对44%，P = 0.002）以及较低的SUV（P = 0.036）。区分PTB和肺癌的最佳截断水平为SUV 8.45。此时，敏感性和特异性分别为63.0%和88.9%。本研究结果揭示了区分这两种相似疾病的方法。此外，本研究结果可能会提高人们的认识，即尽管病变的影像学表现可能类似肺癌，但仍应考虑PTB的诊断。PTB的准确诊断意味着患者能够避免接受带来高额经济负担的不必要手术。
