Factors for the Early Revision of Misdiagnosed Tuberculosis to Lung Cancer: A Multicenter Study in A Tuberculosis-Prevalent Area

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.

Lung gene expression signatures suggest pathogenic links and molecular markers for pulmonary tuberculosis, adenocarcinoma and sarcoidosis

“…Pulmonary TB patients may share similar symptoms and signs with lung cancer or sarcoidosis patients 4 , 6 , 16 . In some cases, imaging examinations could not discriminate between TB and cancer 15 , 57 , and the histological appearances of TB and sarcoidosis may be indistinguishable 6 , 11 , 16 . Also, false-negative culturing results of Mtb may further challenge the differential diagnosis between TB and cancer 13 , 15 .…”

“…In some cases, imaging examinations could not discriminate between TB and cancer 15 , 57 , and the histological appearances of TB and sarcoidosis may be indistinguishable 6 , 11 , 16 . Also, false-negative culturing results of Mtb may further challenge the differential diagnosis between TB and cancer 13 , 15 . According to a report, TB and malignancy can be mistaken for each other at first clinical presentation in nearly one-third of the reporting cases 14 .…”

“…Both diseases could form similarly well-organized granulomatous lesions, and mycobacterial genetic material and antigens can be found in a considerable proportion of sarcoidosis patients, suggesting that infection with mycobacteria, such as Mtb, might be an important pathophysiologic factor for sarcoidosis 6 , 11 . More importantly, pulmonary TB could mimic lung cancer 12 – 15 or sarcoidosis 6 , 16 in some cases, which may challenge the diagnosis and delay the treatment. Therefore, unfolding the pathogenetic links and differences among TB, LUAD and sarcoidosis can help better understand Mtb pathogenesis and clinical outcomes, as well as benefit differential diagnosis of these clinically important lung diseases.…”

Epidemiological Study of Risk Factors for Lung Cancer in KwaZulu-Natal, South Africa

“…Due to this inflammation and scarring that is associated with TB, it is possible that TB plays a role as either the initiator or promoter of lung cancer [ 35 ]. Another alternate explanation of this association of lung cancer with TB is the misdiagnosis of lung cancer for TB because of similar pulmonary symptoms and presentation [ 36 ]. Studies indicate that those with a lung cancer diagnosis are first diagnosed as TB before lung cancer [ 37 , 38 ] with one study having an incidence of 14.6% of patients with misdiagnosis of lung cancer as TB [ 36 ].…”

“…Another alternate explanation of this association of lung cancer with TB is the misdiagnosis of lung cancer for TB because of similar pulmonary symptoms and presentation [ 36 ]. Studies indicate that those with a lung cancer diagnosis are first diagnosed as TB before lung cancer [ 37 , 38 ] with one study having an incidence of 14.6% of patients with misdiagnosis of lung cancer as TB [ 36 ]. The misdiagnosis delays the cancer diagnosis therefore influencing prognosis.…”