AI Article Synopsis
- A pneumonic infiltrate may mask hidden lung cancer, making diagnosis difficult and delayed, which this study aims to address.
- A retrospective study compared undiagnosed lung cancer patients presenting with symptoms of community-acquired pneumonia to matched controls, identifying six key variables that increase the likelihood of an underlying lung cancer.
- A new clinical scoring system was developed from these variables, showing high sensitivity and specificity, which could help clinicians recognize potential lung cancer cases earlier in patients presenting with pneumonia-like symptoms.
Article Abstract
Background: A pneumonic infiltrate might hide an occult lung cancer (LC). This awareness depends on each clinician personal experience, turning definitive LC diagnosis challenging and possibly delayed. In this study we aimed to develop a clinical score to better identify those cases.
Materials And Methods: We conducted a retrospective case-control study, including previously undiagnosed LC patients admitted in our institution, with a presumptive suspicious of community acquired pneumonia (CAP). Cases were compared with random CAP inpatient controls, using a matched 2:1 ratio. Demographic, clinical, and laboratorial variables were assessed for a possible association with the presence of a CAP with underlying LC (CAP-uLC).
Results: Among 535 hospitalized LC patients, 43 cases had a presentation compatible with CAP and were compared with 86 CAP controls. A scoring system was built using 6 independent variables, which positively correlated with CAP-uLC: smoking history (OR: 8.3 [1.9-36.2]; p = 0.005); absence of fever (6.5 [2.0-21.5]; p = 0.002); sputum with blood (5.9 [1.2-29.9]; p = 0.033); platelet count ≥ 232x10/μL (5.8 [1.6-20.6]; p = 0.006); putative alternative diagnosis than CAP (4.6 [1.5-14.7]; p = 0.009); and duration of symptoms ≥ 10 days (3.7 [1.1-13.0]; p = 0.037). Our score presented an AUC of 0.910 (95 % CI, 0.852-0.967; p < 0.001), a sensitivity of 88.1 % and specificity of 84.7 %, in predicting the risk of presenting a CAP-uLC, when set to a cutoff of 18.
Conclusion: We propose a novel risk score aimed to aid clinicians identifying patients with CAP-uLC in the acute setting, possibly prompting early LC diagnosis.
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| http://dx.doi.org/10.1016/j.rmed.2024.107675 | DOI Listing |
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