ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ПОЛОСТНЫХ ОБРАЗОВАНИЙ ЛЕГКИХ ВО ФТИЗИАТРИЧЕСКОЙ ПРАКТИКЕ

Abstract

Objective: to describe the structure of nosological forms of pulmonary diseases in differential diagnosis of lung cavities in a federal TB institution and assess the effectiveness of diagnosis verification based on studies of different samples (sputum, bronchoscopic samples, resection samples). Materials and methods. We conducted a cohort prospective open study. We examined 122 patients with newly detected lung cavities at the Central TB Research Institute: 60 (49%) women and 62 (51%) men with the average age of 42.9 ± 14.2 years. Results. Among 122 patients with lung cavities the following diagnoses were verified: 41.8% of pulmonary TB cases, 41% of pulmonary mycobacteriosis cases, 11.5% of destructive pneumonia cases, and 5.7% of lung cancer cases. Destructive TB was verified based on: complex sputum study – 54.9%, complex study of bronchoscopic samples – 91.3% (р = 0.003), and complex study of resection samples – 100% of cases (р = 0.016). The study of bronchoscopic samples was the most significant for the verification of destructive pneumonia – 100% vs. 28.6% of cases verified by sputum study (р < 0.001, χ2 = 12.245). Pulmonary mycobacteriosis was verified based on sputum study in 28% of cases vs. 44.4% of cases verified by bronchoscopic sample study, though without statistically significant difference (р = 0.223, χ2 = 1.490); only resection sample study enabled to verify the diagnosis in 100% of cases (р < 0.001, χ2 = 17.959). Among patients with pulmonary mycobacteriosis, slowly growing nontuberculous mycobacteria (NTM) were isolated in 92% of cases; the most common were M. avium complex (46%) and M. kansasii (28%). Lung cancer was confirmed by bronchoscopic study in 57.1% of cases, while resection sample study confirmed the diagnosis in 100% of cases. In outpatient settings the verification of lung cavity differential diagnosis based on sputum or bronchoscopic sample study was effective in 79.5% of cases. Hospitalization for surgical diagnostic procedures was required in 20.5% of cases. Conclusion. In the structure of nosological forms of lung cavities pulmonary TB (41.8%) and pulmonary mycobacteriosis (41%) prevailed. We established high effectiveness of diagnosis verification in lung cavity patients based on complex study of bronchoscopic samples or resection samples performed in the federal TB centre. In general, invasive diagnostic procedures were required in 82.8% of cases; the diagnosis verification was achieved due to bronchoscopic sampling in 67.1% of cases, or surgical interventions – in 100% of cases.