Abstract
Background: Lung cancer misdiagnosed as tuberculosis (TB) is not rare, but the factors associated with early diagnosis revision remain unclear. Methods: We screened the cases with TB notification from 2007 to 2018 and reviewed those with misdiagnosis with a revised diagnosis to lung cancer. We analyzed the factors associated with early diagnosis revision (≤1 months) and early obtained pathology (≤1 months) using multivariable Cox regression. Results: During the study period, 45 (0.7%) of 6683 patients were initially notified as having TB, but later diagnosed with lung cancer. The reasons for the original impression of TB were mostly due to image suspicion (51%) and positive sputum acid-fast stain (AFS) (27%). Using multivariable Cox proportional regression, early diagnosis revision was associated with obtaining the pathology early, lack of anti-TB treatment, and negative sputum AFS. Furthermore, the predictors for early obtained pathology included large lesion size (>3 cm), presence of a miliary radiological pattern, no anti-TB treatment, and a culture-negative result when testing for nontuberculous mycobacteria (NTM) using multivariable Cox regression. Conclusion: In patients who are suspected to have TB but no mycobacterial evidence is present, lung cancer should be kept in mind and pathology needs to be obtained early, especially for those with small lesions, radiological findings other than the miliary pattern, and a culture positive for NTM.
Highlights
Tuberculosis (TB) remains the most common infectious disease worldwide [1] and, according to the World Health Organization (WHO), an estimated 10.0 million people had active TB, with 1.3 millionTB-related deaths reported in 2017 globally [2,3]
The diagnoses of 978 (14.6%) and 45 (0.7%) had been revised to non-TB causes and stain (AFS) was positive for 20% and the lesion size was around 4.7 cm
Acid-fast stain (AFS) was positive for 20% and the lesion size was around 4.7 cm
Summary
Tuberculosis (TB) remains the most common infectious disease worldwide [1] and, according to the World Health Organization (WHO), an estimated 10.0 million people had active TB, with 1.3 millionTB-related deaths reported in 2017 globally [2,3]. The diagnosis tools regarding TB have been improved in recent decades [6], there are still many cases diagnosed using clinical suspicion without positive culture evidence [7,8,9,10] due to time constraints [11]. We analyzed the factors associated with early diagnosis revision (≤1 months) and early obtained pathology (≤1 months) using multivariable Cox regression. Using multivariable Cox proportional regression, early diagnosis revision was associated with obtaining the pathology early, lack of anti-TB treatment, and negative sputum AFS. The predictors for early obtained pathology included large lesion size (>3 cm), presence of a miliary radiological pattern, no anti-TB treatment, and a culture-negative result when testing for nontuberculous mycobacteria (NTM) using multivariable Cox regression
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