Abstract
INTRODUCTION: Lung cancer can be masked by coexisting stable tuberculosis lesions, which may result in delayed lung cancer diagnosis and treatment. Information about pulmonary tuberculosis patients who are at high-risk of developing lung cancer is scarce. We aimed to examine the value of chest computed tomography (CT) in evaluating lung cancer in a lobe affected by stable pulmonary tuberculosis in middle-aged and elderly patients. METHODS: In this single-centered, retrospective, observational study, we enrolled 41 middle-aged and elderly patients with pulmonary tuberculosis who developed lung cancer in the same lobe from January 30, 2011 to December 30, 2020. Comparisons of the clinical and chest CT data were made with age-matched and sex-matched control groups of patients with stable pulmonary tuberculosis but no lung cancer diagnosis (n = 38). RESULTS: Seventeen patients in the lung cancer group (41%) were initially misdiagnosed. Compared to lesions in the control group, lesions in the lung cancer group were significantly more likely to demonstrate the following CT features: large size, vessel convergence, lobulation, spiculation, spinous protuberance, bronchial obstruction or stenosis, vacuolation, ground-glass opacification, heterogeneous or homogeneous enhancement, and gradual increase in size. Nodular enlargement showed the best diagnostic performance in the diagnosis of lung cancer in a lobe affected by tuberculosis (area under the receiver operating characteristic curve = 0.974; P <0.001; accuracy = 98.2%; sensitivity =94.7%; specificity = 100%). CONCLUSION: Chest CT might play an important role in early diagnosis of lung cancer in a lobe affected by tuberculosis. Regular CT re-examination is necessary in continuous controls monitoring of patients with stable pulmonary tuberculosis. The study indicates necessity of prospective study in this field.