DIAGNOSTIC VALUE OF HIGH-RESOLUTION COMPUTED TOMOGRAPHY IN DISTINGUISHING TUBERCULOSIS GRANULOMA AND MALIGNANT PULMONARY NODULE
DOI:
https://doi.org/10.66021/pakmcr946Keywords:
HRCT, Pulmonary Tuberculosis, Malignant Pulmonary Nodule, Tree-in-Bud, Calcification, Sensitivity, SpecificityAbstract
Background:
Pulmonary tuberculosis and malignant pulmonary nodules often present with overlapping imaging features, making accurate differentiation a significant clinical challenge. Misdiagnosis can result in delayed cancer treatment or unnecessary invasive procedures for benign lesions. High-resolution computed tomography (HRCT) offers detailed morphological assessment of pulmonary nodules and may aid in distinguishing tuberculous granulomas from malignancy. Accurate non-invasive differentiation is particularly important in tuberculosis-endemic regions to guide appropriate clinical management.
Objectives:
To evaluate the diagnostic performance of HRCT features in differentiating tuberculous granulomas from malignant pulmonary nodule.
Methodology:
A total of 75 patients (42 tuberculous granulomas, 33 malignant nodules) were included. HRCT was performed, and lesions were analyzed for location, morphology, calcification, cavitation, Tree-in-Bud pattern, and mediastinal or hilar lymphadenopathy. Cross-tabulation, sensitivity, specificity, positive predictive value, negative predictive value, and ROC analysis were performed to assess the discriminative power of each feature.
Results:
Lesions were most commonly in the right lobe (40%), followed by left lobe (30.7%) and bilateral involvement (24%). Centrilobular and smooth nodules predominated in TB, while spiculated and lobulated nodules were characteristic of malignancy. Calcification showed sensitivity 64.3% and specificity 84.8% for TB. Cavitation had low diagnostic value (sensitivity 35.7%, specificity 51.5%). Tree-in-Bud pattern was exclusive to TB with 100% specificity and an AUC of 0.798. Lymphadenopathy was common in both conditions, limiting specificity.
Conclusion:
High-resolution CT distinguishes tuberculous granulomas from malignant pulmonary nodules with high sensitivity and specificity. Features such as Tree-in-Bud pattern, calcification, and spiculated margins significantly aid accurate diagnosis. This approach allows reliable, non-invasive evaluation in TB-endemic regions.
