Presentation on theme: "Pulmonary Tuberculosis and Lung Cancer. Diagnosis of Primary Tumor Sputum Cytology Flexible Bronchoscopy and Biopsy TTNA transthoracic needle aspiration."— Presentation transcript:
Pulmonary Tuberculosis and Lung Cancer
Diagnosis of Primary Tumor Sputum Cytology Flexible Bronchoscopy and Biopsy TTNA transthoracic needle aspiration Cell Type Accuracy
Central lesion, bronchoscopy is the most sensitive way to confirm a diagnosis of cancer. Small (ie, < 2 cm) peripheral lesion, the sensitivity of bronchoscopy is low. TTNA has a much higher sensitivity than bronchoscopy
Difficult to differential diagnosis The diagnosis of lung cancer superimposed on pulmonary tuberculosis is difficult especial the Acid fast stain is positive. Thorac Med vol.17 no Indian Journal of Chest Diseases & Allied Sciences. 39(4):251-4, 1997 Oct-Dec.
In the endemic area of tuberculosis, there are many cases that present tuberculosis as a solitary pulmonary nodule (SPN) on chest radiographs. hardly to D.D from lung cancer Respiratory Medicine. 90(3):139-43, 1996 Mar.
The possibility of coexisting tuberculosis should be kept in mind in patients with a malignancy, especially those with lung carcinoma in countries with a high prevalence of tuberculosis Tumori. 88(3):251-4, 2002 May-Jun Folia Histochemica et Cytobiologica. 39 Suppl 2:73-4, 2001
Incidence The incidence of lung cancer in tuberculosis patients was about 2%. Both lung cancer and pulmonary tuberculosis have a higher incidence of upper lober involvement. Thorac Med :
The incidence of lung cancer is higher in patients with pulmonary tuberculosis (TB). Japanese Journal of Clinical Oncology. 26(5):322-7, 1996 Oct Thorac Med vol.17 no Southern Medical Association Journal. 81(3):337-40, 1988 Mar.
The risk factors of lung cancer Cigarette smoking, Occupations, Previous tuberculosis history found to independently correlate with an elevated risk of lung cancer for male patients. Cancer Causes & Control.12(4): , 2001 May)
TB scar v.s Lung Cancer Significant association between tuberculous scars and carcinoma of the lung. The possibility of malignancy has to be kept in mind when radiological scanning reveal the presence of lung scars. European Journal of Radiology. 7(3):163-4, 1987 Aug.
The Marker - BAL neopterin BAL neopterin levels are elevated in patients with lung cancer, especially the small-cell carcinoma type. The levels of neopterin in BAL fluid may reflect the degree of disease activity in pulmonary tuberculous patients.
Derived from guanosine triphosphate Produced by stimulated macrophages under the influence of gamma-interferon of lymphocyte origin. An excellent marker for the activation of the monocyte/macrophage.
Serum adenosine deaminase The mean (+/- SD) of ADA activity was (4.47), 7.29 (1.08), (1.95) and 2.23 (1.00) units/litre in tuberculosis, malignancy, non-tubercular pulmonary diseases and healthy controls.
Serum C-reactive protein Tuberculous patients with cavitation in chest X-ray had significantly higher levels of CRP than those without as well as healthy controls. Normal CRP did not exclude tuberculosis Infection. 17(1):13-4, 1989 Jan-Feb
Reactivation of tuberculosis Deterioration of immunity due to local or systemic effects of the tumor itself and/or administered chemotherapeutics or radiotherapy may play roles increasing the mortality in patients with various malignancies Tumori. 88(3):251-4, 2002 May-Jun
Evaluation methods Direct microscopic evaluation Sputum specimens Materials obtained by fiberoptic bronchoscopy should be cultivated for tuberculosis.
Differential Diagnosis Tools MR imaging is a helpful adjunctive method in terms of differentiating a tuberculoma from a malignant tumor Journal of Magnetic Resonance Imaging. 11(6):629-37, 2000 Jun
Differential Diagnosis Tools Diagnostic bronchoscopy under fluoroscopic guidance is a useful tool in evaluation of patients with a peripheral pulmonary nodule Minimize unnecessary thoracotomy and give way for proper medication as early as possible.
Differential Diagnosis Tools FDG-PET can identify malignant pulmonary lesions both in patients without and with a history of prior malignancy with a high sensitivity and negative predictive value for lesions greater than 1 cm.
Differential Diagnosis Tools Differentiating tuberculosis or mycobacteriosis from bronchogenic carcinoma, metastasis, or pneumonia was difficult and biopsy was often necessary.
Differential Diagnosis Tools Combined assays of CEA, CA 19-9, and ADA may be useful in distinguishing pleural effusions due to malignancies from those of tuberculous origin
Treatment Three-four-drug anti-tuberculosis regimens should be given, especially in countries with high drug-resistance rates for eradicating tuberculosis.
Treatment Surgery treatment of clinical patterns of pulmonary tubercolosis unresponsive to medical treatment May be underlying lung cancer
Survival is shorter in lung cancer patients who present initially with active TB than in those who do not have TB. Japanese Journal of Clinical Oncology. 26(5):322-7, 1996 Oct.