Zhang Jingping, Han Tingting, Ren Jialiang, Jin Chenwang, Zhang Ming, Guo Youmin
Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an 710061, China.
GE Healthcare China, Daxing District, Tongji South Road No.1, Beijing 100176, China.
Diagnostics (Basel). 2021 May 21;11(6):930. doi: 10.3390/diagnostics11060930.
Pulmonary tuberculoma can mimic lung malignancy and thereby pose a diagnostic dilemma to clinicians. The purpose of this study was to establish an accurate, convenient, and clinically practical model for distinguishing small-sized, noncalcified, solitary pulmonary tuberculoma from solid lung adenocarcinoma.
Thirty-one patients with noncalcified, solitary tuberculoma and 30 patients with solid adenocarcinoma were enrolled. Clinical characteristics and CT morphological features of lesions were compared between the two groups. Multivariate logistic regression analyses were applied to identify independent predictors of pulmonary tuberculoma and lung adenocarcinoma. Receiver operating characteristic (ROC) analysis was performed to investigate the discriminating efficacy.
The mean age of patients with tuberculoma and adenocarcinoma was 46.8 ± 12.3 years (range, 28-64) and 61.1 ± 9.9 years (range, 41-77), respectively. No significant differences were observed concerning smoking history and smoking index, underlying disease, or tumor markers between the two groups. Univariate and multivariate analyses showed age and lobulation combined with pleural indentation demonstrated excellent discrimination. The sensitivity, specificity, accuracy, and the area under the ROC curve were 87.1%, 93.3%, 90.2%, and 0.956 (95% confidence interval (CI), 0.901-1.000), respectively.
The combination of clinical characteristics and CT morphological features can be used to distinguish noncalcified, solitary tuberculoma from solid adenocarcinoma with high diagnostic performance and has a clinical application value.
肺结核球可酷似肺部恶性肿瘤，从而给临床医生带来诊断难题。本研究的目的是建立一种准确、便捷且临床实用的模型，以区分小尺寸、非钙化的孤立性肺结核球与实性肺腺癌。
纳入31例非钙化的孤立性结核球患者和30例实性腺癌患者。比较两组病变的临床特征和CT形态学特征。应用多因素逻辑回归分析确定肺结核球和肺腺癌的独立预测因素。进行受试者操作特征（ROC）分析以研究鉴别效能。
结核球患者和腺癌患者的平均年龄分别为46.8±12.3岁（范围28 - 64岁）和61.1±9.9岁（范围41 - 77岁）。两组在吸烟史、吸烟指数、基础疾病或肿瘤标志物方面未观察到显著差异。单因素和多因素分析显示年龄以及分叶征合并胸膜凹陷具有良好的鉴别能力。ROC曲线的敏感性、特异性、准确性和曲线下面积分别为87.1%、93.3%、90.2%和0.956（95%置信区间（CI），0.901 - 1.000）。
临床特征与CT形态学特征相结合可用于区分非钙化的孤立性结核球与实性腺癌，具有较高的诊断效能，具有临床应用价值。
