Clinical Study On Differential Diagnosis Of Pulmonary Tuberculoma And Lung Cancer In Pulmonary Nodules

Objective To study pulmonary nodules and analyze the risk factors of lung cancer and pulmonary tuberculosis,and to explore the value of T-Spot.TB and tumor markers combined with CT imaging in the differential diagnosis of lung cancer and pulmonary tuberculosis in pulmonary nodules.Method Patients with pulmonary nodules from January 2014 to June 2018 in our hospital were enrolled.Clinical data were collected including gender,ethnicity,age,duration of illness,symptoms(cough,hemoptysis,chest pain,fever,weight loss),smoking index,tumor past history,history of tuberculosis,history of diabetes and family history of cancer.Imaging data were collected including diameter,location,lobulated sign,burr sign,vascular bundle sign,pleural intaglio sign,vacuole sign,cavity,calcification,satellite foci,border and standard uptake value(SUV).Peripheral venous blood was collected from patients before surgery,and T-Spot.TB results,fibrinogen,erythrocyte sedimentation rate,neutrophil lymphocyte ratio(NLR),C-reactive protein,albumin and adenosine deaminase were collected.Serum tumor markers(TMs)include carcinoembryonic antigen(CEA),neuron-specific enolase(NSE),cytokeratin 19(CYFRA21-1),squamous cell carcinoma antigen(SCC),gastric cancer antigen(CA724))and ovarian cancer-associated antigen(CA125)levels.Logistic regression analysis was used to screen the risk factors of lung cancer and tuberculosis.CT images and serological results of lung cancer and pulmonary tuberculosis were compared and analyzed.The value of CT plain scan,tumor marker detection(TMs),T-Spot.TB,CT+TMs and CT+T-Spot.TBin differential diagnosis of lung cancer and pulmonary tuberculosis in pulmonary nodules was discussed.Result 1.Multivariate logistic regression analysis showed that sex,calcification,CYFRA21-1 and T-Spot.TB were independent predictors of pulmonary tuberculosis compared with lung cancer.Compared with lung cancer,pulmonary tuberculoma in pulmonary nodules with older age and positive expression of CYFRA-21 may be lung cancer.Compared with lung cancer,pulmonary tuberculosis may be tuberculoma in male and CT images with calcification and T-Spot.TB positive pulmonary nodules.The sensitivity,specificity and coincidence rates of plain CT scan alone for pulmonary tuberculosis in pulmonary nodules were 61.9%,75.0% and 69.9%,respectively.The sensitivity,specificity and coincidence rates of plain CT scan for lung cancer in pulmonary nodules were 74.0%,61.9% and 69.3%,respectively.The sensitivity,specificity and coincidence rates of T-Spot.TB detection for pulmonary tuberculosis in pulmonary nodules were 61.9%,77.0% and 71.1%,respectively.The sensitivity,specificity and coincidence rates of single tumor marker detection for lung cancer in pulmonary nodules were 74.5%,69.8% and 72.7%,respectively.The sensitivity,specificity and coincidence of CT combined with T-Spot.TB in the diagnosis of pulmonary tuberculosis in pulmonary nodules were 87.3%,75.5% and 80.1%,respectively.The sensitivity,specificity and coincidence rates of CT and TMs in the diagnosis of lung cancer in pulmonary nodules were 93.4%,77.8% and 87.3%,respectively.Conclusion Elderly and CYFRA-21 positive pulmonary nodules are more likely to be lung cancer.Young male pulmonary nodules with calcified nodules and T-Spot.TB positive on CT images are more likely to be tuberculoma.CT+TMs and CT+T-Spot.TB have higher sensitivity,specificity and coincidence rate for differential diagnosis of lungcancer and tuberculosis in pulmonary nodules,and have certain clinical value.