Itoh Naoya, Shimizu Junichi, Murakami Hiromi, Hida Toyoaki
Division of Infectious Diseases Aichi Cancer Center Hospital Nagoya Japan.
Collaborative Chairs Emerging and Reemerging Infectious Diseases National Center for Global Health and Medicine Graduate School of Medicine Tohoku University Miyagi Japan.
J Gen Fam Med. 2020 Oct 14;22(1):38-42. doi: 10.1002/jgf2.383. eCollection 2021 Jan.
Pulmonary infections can imitate pulmonary neoplasms. Pulmonary tuberculosis (TB) is a typical example of an infection that mimics cancer and results in unexpected exposure of healthcare workers to TB. A large number of patients with suspected lung malignancy are referred to cancer centers, although the epidemiology of the final diagnosis is unclear in Japan. This study aimed to determine the frequency and nature of pulmonary infections that imitate malignancy among patients with presumed lung cancer that is subsequently diagnosed as a pulmonary infection based on bronchoscopy findings. We also aimed to identify the prevalence of formerly undiagnosed pulmonary tuberculosis that could pose an occupational risk to healthcare workers.
This single-center retrospective cross-sectional study included patients with suspected pulmonary malignancy who underwent bronchoscopy at a tertiary care cancer center in Japan between April 2017 and March 2020. Electronic medical records of the bronchoscopy database were reviewed to identify the final diagnoses recorded by physicians.
Among the 460 patients enrolled in the present study, 362 (78.7%) and 8 (1.7%) had primary or metastatic pulmonary lesions and benign lesions, respectively. Sixty-six patients (14.3%) had nonspecific findings or other pulmonary diseases. Infection was confirmed in 24 patients (5.2%). Mycobacterial infections (n = 16) were the most frequent infectious disease; four patients had TB and 12 had nontuberculous mycobacterial infections.
Despite the rare occurrence of TB in patients with suspected lung malignancy, healthcare workers should remain vigilant regarding the possibility of TB to prevent occupational exposure during invasive procedures such as routine bronchoscopy.
肺部感染可能会模仿肺部肿瘤。肺结核（TB）是一种典型的感染，它会模仿癌症，并导致医护人员意外接触到结核病。大量疑似肺部恶性肿瘤的患者被转诊至癌症中心，尽管在日本最终诊断的流行病学情况尚不清楚。本研究旨在确定在随后根据支气管镜检查结果被诊断为肺部感染的疑似肺癌患者中，模仿恶性肿瘤的肺部感染的频率和性质。我们还旨在确定以前未被诊断出的可能对医护人员构成职业风险的肺结核的患病率。
这项单中心回顾性横断面研究纳入了2017年4月至2020年3月期间在日本一家三级医疗癌症中心接受支气管镜检查的疑似肺部恶性肿瘤患者。对支气管镜数据库的电子病历进行回顾，以确定医生记录的最终诊断。
在本研究纳入的460例患者中，分别有362例（78.7%）和8例（1.7%）患有原发性或转移性肺部病变以及良性病变。66例患者（14.3%）有非特异性表现或其他肺部疾病。24例患者（5.2%）确诊为感染。分枝杆菌感染（n = 16）是最常见的传染病；4例患者患有结核病，12例患有非结核分枝杆菌感染。
尽管疑似肺部恶性肿瘤患者中结核病的发生率较低，但医护人员在进行常规支气管镜检查等侵入性操作时，仍应警惕结核病的可能性，以防止职业暴露。
