ЭФФЕКТИВНОСТЬ ВЕРИФИКАЦИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ У БОЛЬНЫХ СО ЗЛОКАЧЕСТВЕННЫМИ НОВООБРАЗОВАНИЯМИ ВНЕЛЕГОЧНОЙ И ЛЕГОЧНОЙ ЛОКАЛИЗАЦИЙ

Abstract

Aim: to analyze effectiveness of the algorithm for verification of pulmonary TB and the structure of clinical forms of pulmonary TB in patients with malignancies of extrapulmonary or pulmonary localizations. Materials and methods. A cohort retrospective study included 126 patients with malignancies and the diagnosis of active TB or residual post-TB changes or other lung diseases verified by sputum studies (stage 1), bronchoscopy (stage 2), and diagnostic surgery (stage 3).Results. The effectiveness of diagnosis verification based on three stages was 96%. The diagnosis of TB was significantly more frequent – in 40.5% (р < 0.001) than sarcoid reactions – 11.1%, metastatic tumors in the lungs – 15.1%, newly detected malignancies with comorbid TB – 6.3%, or bronchiectasis – 27% of cases. Stage 1 was effective for diagnosis verification in 30.9%, stage 2 – 61.6%, and stage 3 – 100% of cases. In 51 TB patients extrapulmonary malignancies prevailed – 84.3% vs lung cancer – 15.7% (р = 0.001); the most common were breast cancer (25.4%) and gastrointestinal cancer (15.7%). In 60.8% of cases TB was detected during complete/incomplete remission of cancer, in 21.5% – during new detection of cancer/TB comorbidity, in 17.6% – during cancer recurrence (р < 0.001). Active TB was diagnosed in 60.8%, residual post-TB changes – 39.2% of cases (р < 0.05). We established the prevalence of infiltrative pulmonary TB (25.8%) and intrathoracic lymph node TB (25.8%) vs other forms of pulmonary TB (р < 0.05). The detection of M. tuberculosis (MTB) DNA by molecular genetic methods was higher (77.4% of observations) than the detection of AFB by luminescent microscopy (58.1%) or MTB by cultural methods (38.7%) (р < 0.05). We obtained results of drug susceptibility testing in 67.9% of cases. TB was caused by drug susceptible MTB in в 68.4% and drug resistant MTB – 31.6% of cases (р < 0.05). Extensive drug resistance was determined in 15.7%, multiple drug resistance – 5.2%, and poly/monoresistance – 5.2% of cases. Conclusion. Among patients with malignancies, pulmonary TB was commonly detected during cancer remission; in two thirds of observations TB was confirmed by detection of MTB in sputum samples and bronchobiopsies, predominantly by molecular genetic methods; two thirds of cases had drug susceptible TB.