Discriminating Small-Sized (2 Cm or Less), Noncalcified, Solitary Pulmonary Tuberculoma and Solid Lung Adenocarcinoma in Tuberculosis-Endemic Areas

Background: Pulmonary tuberculoma can mimic lung malignancy and thereby pose a diagnostic dilemma to clinicians. The purpose of this study was to establish an accurate, convenient, and clinically practical model for distinguishing small-sized, noncalcified, solitary pulmonary tuberculoma from solid lung adenocarcinoma.

Methods: Thirty-one patients with noncalcified, solitary tuberculoma and 30 patients with solid adenocarcinoma were enrolled. Clinical characteristics and CT morphological features of lesions were compared between the two groups. Multivariate logistic regression analyses were applied to identify independent predictors of pulmonary tuberculoma and lung adenocarcinoma. Receiver operating characteristic (ROC) analysis was performed to investigate the discriminating efficacy.

Results: The mean age of patients with tuberculoma and adenocarcinoma was 46.8 ± 12.3 years (range, 28-64) and 61.1 ± 9.9 years (range, 41-77), respectively. No significant differences were observed concerning smoking history and smoking index, underlying disease, or tumor markers between the two groups. Univariate and multivariate analyses showed age and lobulation combined with pleural indentation demonstrated excellent discrimination. The sensitivity, specificity, accuracy, and the area under the ROC curve were 87.1%, 93.3%, 90.2%, and 0.956 (95% confidence interval (CI), 0.901-1.000), respectively.

Conclusion: The combination of clinical characteristics and CT morphological features can be used to distinguish noncalcified, solitary tuberculoma from solid adenocarcinoma with high diagnostic performance and has a clinical application value.