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

1
Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan
2
College of Medicine, National Taiwan University, Taipei 100, Taiwan
3
Department of Internal Medicine, National Yang-Ming University Hospital, Yilan County 260, Taiwan
4
Division of Pulmonary Medicine, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
5
Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung 824, Taiwan
6
Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 824, Taiwan
7
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County 640, Taiwan
*
Author to whom correspondence should be addressed.
Equal contribution equally to this work.
J. Clin. Med. 2019, 8(5), 700; https://doi.org/10.3390/jcm8050700
Received: 2 April 2019 / Revised: 13 May 2019 / Accepted: 15 May 2019 / Published: 17 May 2019
(This article belongs to the Special Issue Host-Directed Therapies for Tuberculosis)
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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. View Full-Text
Keywords: tuberculosis; lung cancer; misdiagnosis; invasive procedure; revising tuberculosis; lung cancer; misdiagnosis; invasive procedure; revising
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Shu, C.-C.; Chang, S.-C.; Lai, Y.-C.; Chang, C.-Y.; Wei, Y.-F.; Chen, C.-Y. Factors for the Early Revision of Misdiagnosed Tuberculosis to Lung Cancer: A Multicenter Study in A Tuberculosis-Prevalent Area. J. Clin. Med. 2019, 8, 700.

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