Abstract
Background. 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. Methods. 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. Results. 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. Conclusion. 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.
Highlights
The numbers of smokers among pulmonary tuberculoma and lung adenocarcinoma patients were (35.5%) and (40.0%), with mean smoking indexes of 166.1 ± 285.6 and 349.7 ± 789.6, respectively, but there were no significant differences between the two groups
The sensitivity, specificity, and accuracy in discriminating tuberculoma and adenocarcinoma were 87.1%, 93.3%, and 90.2%, respectively; the positive predictive value (PPV) was 93.1%, and the negative predictive value (NPV) was 87.5%
These analyses indicate that age in combination with lobulation and pleural indentation showed an excellent capacity in discriminating noncalcified, solitary pulmonary tuberculoma and solid adenocarcinoma with a maximum diameter of 2 cm or less
Summary
Pulmonary tuberculomas are round, well-defined lesions with small satellite lesions in the immediate vicinity of the main lesion, and calcification can be seen in 20% to 30% of them [3]. They can sometimes present as noncalcified, solid solitary pulmonary nodules (SPNs) with atypical imaging characteristics such as lobulation, spiculation, vessel convergence, and pleural indentation, signs that are consistent with a lung malignancy, representing a diagnostic dilemma for clinicians. Accurate differentiation between pulmonary tuberculoma and lung adenocarcinoma is pivotal because this prompts clinicians to develop an appropriate management plan. This involves the avoidance of unnecessary therapeutic procedures, while for lung adenocarcinoma, this improves the treatment outcome and prognosis
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