CHEN Qirui 1 , LIU Yan 2 , SI Lifang 3 , HU Bin 1 , LI Tong 1 , LI Hui 1
  • 1. Department of Thoracic Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, P.R.China;
  • 2. Department of Respiratory and Critical Care Medicine, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, P.R.China;
  • 3. Department of Ridiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, P.R.China;
LI Hui, Email: huilee@vip.sina.com
Lung cancer; benign lung disease; CT characteristics; clinical characteristics; differential diagnosis; misdiagnosis
10.7507/1007-4848.201712080
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Objective  To improve accuracy of clinical diagnosis through analyzing the CT characteristics and clinical manifestations of patients with benign lung diseases whose CT manifestations initially led to a suspicion of lung cancer. Methods  This study collected 2 239 patients of benign lung disease verified by postoperative pathology in the Department of Thoracic Surgery, Beijing Chao-yang Hospital from June 2006 to December 2016. Lesions of 173 patients (101 males and 72 females with a mean age of 56.0 years) were considered very likely to be malignant on preoperative contrast CT scan, which were sorted to 20 types of lung diseases, and the 20 types of diseases contained 907 patients diagnosed or misdiagnosed. Statistical analyses were performed using the CT and clinical characteristics of the 173 patients. Results  Among the 907 patients with benign lung disease, the benign pathologies that were most commonly misdiagnosed by preoperative enhanced CT were pulmonary leiomyoma (100.0%), pulmonary actinomycosis (75.0%), pulmonary cryptococcosis (71.4%), sclerosing hemangioma (50.0%) and organizing pneumonia (44.2%). Among the 173 patients with benign diseases, the most common diseases were tuberculosis (29.5%), organizing pneumonia (28.9%), pulmonary hamartoma (6.4%) and pulmonary abscess (6.4%). In the 173 patients, 17.3% had fever, 56.6% coughing, 8.7% yellow sputum, 28.9% hemoptysis, 16.2% chest pain, 18.5% elevated leukocyte counts and 4.6% elevated carcinoembryonic antigen levels. Most of the CT manifestations consisted of nodular or mass shadows, 70.5% of which had foci≤3 cm and manifestations were similar to those of lung cancer, such as a spiculated margin (49.1%), lobulation (33.5%), pleural indentation (27.2%) and significant enhancement (39.3%). Furthermore, some patients had uncommon tumor signs, such as calcification (12.7%), central liquefactive necrosis (18.5%), satellite foci (9.8%) and multiple pulmonary nodules (42.2%). Moreover, 24.3% of the patients had enlarged lymph nodes of the mediastinum or hilum. Conclusion  As the CT manifestations of some benign lung conditions are similar to those of lung cancer, careful differential diagnosis is necessary to identify the basic characteristics of the disease when the imaging results are ambiguous, and the diagnosis of a lung disease need incorporate the patients' clinical characteristics and a comprehensive analysis.

Citation： CHEN Qirui, LIU Yan, SI Lifang, HU Bin, LI Tong, LI Hui. Characteristics of benign lung diseases mimicking lung cancer in preoperative CT of 173 patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(11): 935-941. doi: 10.7507/1007-4848.201712080 Copy

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