CT在肺癌与肺癌合并肺结核鉴别诊断中的应用价值

doi:10.19871/j.cnki.xfcrbzz.2025.01.004

新发传染病电子杂志 ›› 2025, Vol. 10 ›› Issue (1): 17-21.doi: 10.19871/j.cnki.xfcrbzz.2025.01.004

CT在肺癌与肺癌合并肺结核鉴别诊断中的应用价值

温立旻¹, 李晔², 李恒星¹, 林伟¹, 侯代伦²

1.黑龙江省传染病防治院放射诊断科,黑龙江哈尔滨 150500;
2.首都医科大学附属北京胸科医院医学影像科,北京 101149

收稿日期:2024-10-24 出版日期:2025-02-28 发布日期:2025-03-31
通讯作者: 侯代伦,Email：hou.dl@mail.ccmu.edu.cn
基金资助:
1.黑龙江省卫生健康委科研课题（20230909010416）;2.北京市医院管理中心临床医学发展专项“扬帆”计划（XMLX202146）

Application value of CT in the differential diagnosis of lung cancer and lung cancer with tuberculosis

Wen Limin¹, Li Ye², Li Hengxing¹, Lin Wei¹, Hou Dailun²

1. Department of Diagnostic Radiology, Infectious Disease Prevention Hospital of Heilongjiang Province, Heilongjiang Harbin 150500, China;
2. Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China

Received:2024-10-24 Online:2025-02-28 Published:2025-03-31

摘要/Abstract

摘要： 目的通过对比分析肺癌与肺癌合并肺结核的典型CT征象,探寻CT在肺癌与肺癌合并肺结核鉴别诊断中的应用价值。方法回顾性收集首都医科大学附属北京胸科医院100例肺癌（肺癌组）和71例肺癌合并肺结核患者（肺癌合并肺结核组）的临床及影像资料,所有患者均行胸部CT平扫及增强扫描。将2019年6月至2023年1月收治的70例单纯肺癌和51例肺癌合并肺结核患者作为训练集,2017年5月至2019年1月30例单纯肺癌和20例肺癌合并肺结核患者作为测试集。比较两组患者的年龄、性别及CT影像征象的差异,将差异有统计学意义的征象筛选出来,通过多因素逻辑回归构建鉴别诊断模型,并在独立测试集上进行测试,通过受试者操作特征曲线（receiver operator characteristic curve,ROC曲线）评价模型效能。结果年龄、性别、空泡征、血管集束征、胸腔积液、胸膜增厚、强化方式及支气管扩张、狭窄在两组患者间存在差异,且差异有统计学意义(P<0.05);根据这些特征构建的鉴别模型表现优异,训练集的ROC曲线下面积为0.901,测试集为0.871。结论肺癌与肺癌合并肺结核患者的CT征象有重叠,极易混淆,构建的鉴别诊断模型表现良好,有助于鉴别两种疾病。

关键词: 肺癌, 肺癌合并肺结核, 体层摄影术, X线, 鉴别诊断

Abstract: Objective To explore the value of CT in the differential diagnosis of lung cancer and lung cancer combined with tuberculosis by comparing and analyzing the typical CT signs. Method The clinical and imaging data of 100 cases of lung cancer(lung cancer group) and 71 cases of lung cancer complicated with tuberculosis(lung cancer complicated with tuberculosis group) were collected from Beijing Chest Hospital, Capital Medical University retrospectively, All patients underwent plain chest CT scan and contrast -enhanced CT scan. 70 cases of simple lung cancer and 51 cases of lung cancer combined with pulmonary tuberculosis patients admitted from June 2019 to January 2023 were used as the training set, and 30 cases of simple lung cancer and 20 cases of lung cancer combined with pulmonary tuberculosis patients admitted from May 2017 to January 2019 were used as the testing set. Compare the differences in age, gender and CT imaging features between two groups of patients, and select the features with statistically significant differences. The differential diagnosis model was constructed by multi-factor logistic regression and tested on an independent test set. The model performance was evaluated by receiver operator characteristic curve (ROC curve). Result There were significant differences in age, gender, vacuole sign, vascular cluster sign, pleural effusion, pleural thickening, enhancement pattern, bronchiectasis and stenosis between the two groups (P<0.05). The differential model constructed according to these features performed well, with the area under ROC curve of 0.901 in the training set and 0.871 in the test set. Conclusion Patients with lung cancer and lung cancer combined with tuberculosis have overlapping CT signs, which makes it easy to confuse the two diseases. The established differential diagnosis model is good and helpful to distinguish the two diseases.

Key words: Lung cancer, Lung cancer with tuberculosis, Body section radiography, X-ray, Differential diagnosis

中图分类号:

温立旻, 李晔, 李恒星, 林伟, 侯代伦. CT在肺癌与肺癌合并肺结核鉴别诊断中的应用价值[J]. 新发传染病电子杂志, 2025, 10(1): 17-21.

Wen Limin, Li Ye, Li Hengxing, Lin Wei, Hou Dailun. Application value of CT in the differential diagnosis of lung cancer and lung cancer with tuberculosis[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(1): 17-21.

参考文献

[1] 张盼, 黄庆, 汪扬, 等. 非小细胞肺癌动态增强CT扫描下临床表现特征与其病理类型的关系[J].西部医学, 2023, 35(4): 584-587.
[2] 卢春容,谭卫国,陆普选,等. 2023年WHO全球结核病报告:全球与中国关键数据分析[J/CD].新发传染病电子杂志,2023, 8(6): 73-78.
[3] EVMAN S, BAYSUNGUR V, ALPAY L, et al.Management and Surgical Outcomes of Concurrent Tuberculosis and Lung Cancer[J].Thorac Cardiovasc Surg, 2017, 65(7): 542-545.
[4] TANG W, XING W, LI C, et al.Differences in CT imaging signs between patients with tuberculosis and those with tuberculosis and concurrent lung cancer[J].Am J Transl Res, 2022, 14(9): 6234-6242.
[5] HANSELL DM, BANKIER AA, MACMAHON H, et al.Fleischner Society: glossary of terms for thoracic imaging.Radiology[J].2008, 246(3): 697-722.
[6] 张强, 解记臣, 魏志宪. 40岁以下肺癌合并肺结核46例临床分析[J].肿瘤基础与临床, 2008, 21(6): 524-525.
[7] VENTO S, LANZAFAME M.Tuberculosis and cancer: a complex and dangerous liaison[J].Lancet Oncol, 2011, 12(6): 520-522.
[8] HEUVERS ME, AERTS JG, HEGMANS JP, et al.History of tuberculosis as an independent prognostic factor for lung cancer survival[J].Lung Cancer, 2012, 76(3): 452-456.
[9] BOBBA RK, HOLLY JS, LOY T, et al.Scar carcinoma of the lung: a historical perspective[J].Clin Lung Cancer, 2011, 12(3): 148-154.
[10] LONG K, ZHOU H, LI Y, et al.The value of chest computed tomography in evaluating lung cancer in a lobe affected by stable pulmonary tuberculosis in middle-aged and elderly patients: A preliminary study[J].Front Oncol, 2022, 12: 868107.
[11] ABDEAHAD H, SALEHI M, YAGHOUBI A, et al.Previous pulmonary tuberculosis enhances the risk of lung cancer: systematic reviews and meta-analysis[J].Infect Dis (Lond), 2022, 54(4): 255-268.
[12] PARKER CS, SIRACUSE CG, LITLE VR.Identifying lung cancer in patients with active pulmonary tuberculosis[J].J Thorac Dis, 2018, 10(Suppl 28):S3392-S3397.
[13] TANG W, XING W, LI C, et al.Differences in CT imaging signs between patients with tuberculosis and those with tuberculosis and concurrent lung cancer[J].Am J Transl Res, 2022, 14(9): 6234-6242.
[14] ABDEAHAD H, SALEHI M, YAGHOUBI A, et al.Previous pulmonary tuberculosis enhances the risk of lung cancer: Systematic reviews and meta-analysis[J].Infect Dis-Nor, 2022, 54: 255-268.
[15] 丰银平, 郭净, 张尊敬, 等. 气管支气管结核合并肺空洞的临床特征及危险因素研究[J].中国现代医生, 2023, 61(8):5-9.
[16] 申静静, 穆林. 肺结核合并肺癌的CT表现与鉴别诊断探究[J/CD].世界最新医学信息文摘(连续型电子期刊), 2020, 20(11): 186-188.
[17] 杨清伟, 黄松武, 蔡清河, 等. 肺结核合并肺癌的鉴别诊断中CT的应用探究[J].现代医用影像学, 2022, 31(5): 900-902.

CT在肺癌与肺癌合并肺结核鉴别诊断中的应用价值

Application value of CT in the differential diagnosis of lung cancer and lung cancer with tuberculosis

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