Comparison of CT characteristics between pulmonary cryptococcosis and lung cancer presenting as solitary nodules: a meta-analysis_West China Medical Journal

Authors：

LIU Qian , LI Qian ,  BIAN Cuixia

Department of Pulmonary and Critical Care Medicine, Jining First People’s Hospital, Jining, Shandong 272011, P. R. China;

Corresponding?author：

BIAN Cuixia, Email: yzbbc@126.com

Keywords：

Pulmonary cryptococcosis; lung cancer; tomography, X-ray computed; systematic review; meta-analysis

DOI：

10.7507/1002-0179.202310002

Video：

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Objective To systematically review the CT characteristic differences between pulmonary cryptococcosis (PC) and lung cancer presenting as solitary nodules. Methods PubMed, Embase, Web of Science, Cochrane Library, Wanfang, China National Knowledge Infrastructure and SinoMed were searched to collect case-control studies of the patients with PC and lung cancer presenting as solitary nodules on CT. The search period was from databases establishment to December 2023. We conducted a meta-analysis on the included studies. Results A total of 7 studies were included, 342 PC patients, and 370 lung cancer patients. The meta-analysis results showed that compared with lung cancer, PC patients were more likely to have the following characteristics in CT (P<0.05): nodules located in the lower lobe of the lung [odds ratio (OR)=1.91, 95% confidence interval (CI) (1.39, 2.62)], presence of bronchial inflation sign [OR=5.79, 95%CI (1.45, 23.21)], and halo sign [OR=6.64, 95%CI (2.87, 15.38)]. Compared with PC, lung cancer patients were more likely to have the following characteristics in CT (P<0.05): nodules located in the upper lobe of the lung [OR=0.52, 95%CI (0.35, 0.78)], presence of lobulation sign [OR=0.15, 95%CI (0.08, 0.27)], spiculation sign [OR=0.48, 95%CI (0.35, 0.65)], pleural indentation sign [OR=0.15, 95%CI (0.04, 0.50)], and vascular bundle sign [OR=0.20, 95%CI (0.05, 0.77)]. There was no statistically significant difference in CT between PC patients and lung cancer patients in terms of lesion size, relationship with pleura, vacuolar sign, cavity, and whether the broad base was connected to pleura (P>0.05). Conclusions For CT showing solitary nodules, PC nodules are more likely to be distributed in the lower lobe of the lungs, with bronchial inflation sign and halo sign. Lung cancer nodules are more likely to be distributed in the upper lobe of the lungs, with lobulation sign, spiculation sign, pleural indentation sign and vascular bundle sign.

Citation： LIU Qian, LI Qian, BIAN Cuixia. Comparison of CT characteristics between pulmonary cryptococcosis and lung cancer presenting as solitary nodules: a meta-analysis. West China Medical Journal, 2024, 39(4): 521-525. doi: 10.7507/1002-0179.202310002 Copy

1.	Callister ME, Baldwin DR. How should pulmonary nodules be optimally investigated and managed?. Lung Cancer, 2016, 91: 48-55.
2.	Wyker A, Henderson WW. Solitary pulmonary nodule. Treasure Island: StatPearls, 2024.
3.	辛克武. 分析比較CT與普通放射檢查對肺部孤立性球形病變的診斷價值. 現代醫用影像學, 2018, 27(1): 91-93.
4.	Howard-Jones AR, Sparks R, Pham D, et al. Pulmonary cryptococcosis. J Fungi (Basel), 2022, 8(11): 1156.
5.	Choi HS, Kim YH, Jeong WG, et al. Clinicoradiological features of pulmonary cryptococcosis in immunocompetent patients. J Korean Soc Radiol, 2023, 84(1): 253-262.
6.	Lindell RM, Hartman TE, Nadrous HF, et al. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology, 2005, 236(1): 326-331.
7.	陳磊, 楊婧, 胡麗慶, 等. 誤診為肺癌的孤立結節型肺隱球菌病與肺癌的CT影像特征對比研究. 浙江醫學, 2020, 42(22): 2467-2469.
8.	陳倩, 胡恩德, 劉凱麗, 等. 孤立結節型肺隱球菌病與實性肺腺癌的CT鑒別診斷. 中國CT和MRI雜志, 2023, 21(1): 53-55.
9.	毛海霞, 韓砆石, 楊洋, 等. 孤立結節型肺隱球菌病與肺癌的 CT鑒別診斷. 中華臨床醫師雜志(電子版), 2014(17): 3083-3088.
10.	邢維明, 左玉強, 賈麗萍, 等. 孤立結節型肺隱球菌病與周圍型肺癌的CT比較. 齊魯醫學雜志, 2016, 31(2): 152-154, 158.
11.	趙澤鋼, 周新華, 呂巖, 等. 表現為孤立結節的原發性肺隱球菌病CT診斷及鑒別. 中國防癆雜志, 2016, 38(5): 358-363.
12.	Zhao J, Sun L, Sun K, et al. Development and validation of a radiomics nomogram for differentiating pulmonary cryptococcosis and lung adenocarcinoma in solitary pulmonary solid nodule. Front Oncol, 2021, 11: 759840.
13.	仲艷, 王芬, 張騰, 等. 聯合CT影像組學和臨床影像特征在鑒別孤立性肺結節型肺隱球菌病與肺腺癌的應用價值. 影像診斷與介入放射學, 2022, 31(5): 335-339.
14.	谷雷, 文文, 賴國祥. 肺隱球菌病診治進展. 中華醫學雜志, 2020, 100(4): 317-320.
15.	Hsiao PJ, Cheng H, Kao YH, et al. Comparison of laboratory diagnosis, clinical manifestation, and management of pulmonary cryptococcosis: report of the clinical scenario and literature review. Clin Chim Acta, 2022, 524: 78-83.
16.	Hou X, Kou L, Han X, et al. Pulmonary cryptococcosis characteristics in immunocompetent patients-a 20-year clinical retrospective analysis in China. Mycoses, 2019, 62(10): 937-944.
17.	Wu HH, Chen YX, Fang SY. Clinicopathological features of isolated pulmonary cryptococcosis in HIV-negative patients. J Int Med Res, 2020, 48(6): 300060520927877.
18.	Wang T, Liu M, Zhang F. Clinical diagnosis, treatment, and laboratory detection of 50 cases of pulmonary cryptococcosis. Comput Math Methods Med, 2022, 2022: 7981472.
19.	蘭長青, 黃進寶, 黃梅萍, 等. 結節腫塊型肺隱球菌病CT特征分析. 中華放射學雜志, 2015, 49(10): 741-744.
20.	Futatsuya T, Anzawa K, Mochizuki T, et al. Disseminated cutaneous cryptococcosis in an immunocompetent elderly long-term pigeon fancier. J Dermatol, 2020, 47(5): 551-553.
21.	魯興啟, 李躍興, 丁建平, 等. 免疫正常者實變型肺隱球菌病CT特點分析. 中國醫學科學院學報, 2021, 43(2): 216-221.
22.	石鋒, 楊維偉, 金威. 結節型肺隱球菌病CT影像學特征及鑒別價值. 中國CT和MRI雜志, 2021, 19(9): 54-56, 74.
23.	李靜, 陳正賢. 周圍型肺癌支氣管內超聲支氣管充氣征及其病理學基礎. 中國肺癌雜志, 2010, 13(5): 424-431.
24.	Jiang J, Lv ZM, Lv FJ, et al. Clinical and computed tomography characteristics of solitary pulmonary nodules caused by fungi: a comparative study. Infect Drug Resist, 2022, 15: 6019-6028.
25.	周曉秋, 王寶春, 操嘯, 等. 多層螺旋CT征象對孤立性肺結節的診斷價值. 臨床肺科雜志, 2017, 22(12): 2270-2274.
26.	Zhao HC, Xu QS, Shi YB, et al. Clinical-radiological predictive model in differential diagnosis of small (≤ 20 mm) solitary pulmonary nodules. BMC Pulm Med, 2021, 21(1): 281.
27.	江勇. 孤立性肺結節應用CT影像診斷的臨床價值. 影像研究與醫學應用, 2023, 7(7): 140-142.
28.	Zhang Y, Chu Z, Yu J, et al. Computed tomography-based radiomics for identifying pulmonary cryptococcosis mimicking lung cancer. Med Phys, 2022, 49(9): 5943-5952.
29.	Hu B, Xia W, Piao S, et al. A CT-based radiomics integrated model for discriminating pulmonary cryptococcosis granuloma from lung adenocarcinoma-a diagnostic test. Transl Lung Cancer Res, 2023, 12(8): 1790-1801.

1. Callister ME, Baldwin DR. How should pulmonary nodules be optimally investigated and managed?. Lung Cancer, 2016, 91: 48-55.
2. Wyker A, Henderson WW. Solitary pulmonary nodule. Treasure Island: StatPearls, 2024.
3. 辛克武. 分析比較CT與普通放射檢查對肺部孤立性球形病變的診斷價值. 現代醫用影像學, 2018, 27(1): 91-93.
4. Howard-Jones AR, Sparks R, Pham D, et al. Pulmonary cryptococcosis. J Fungi (Basel), 2022, 8(11): 1156.
5. Choi HS, Kim YH, Jeong WG, et al. Clinicoradiological features of pulmonary cryptococcosis in immunocompetent patients. J Korean Soc Radiol, 2023, 84(1): 253-262.
6. Lindell RM, Hartman TE, Nadrous HF, et al. Pulmonary cryptococcosis: CT findings in immunocompetent patients. Radiology, 2005, 236(1): 326-331.
7. 陳磊, 楊婧, 胡麗慶, 等. 誤診為肺癌的孤立結節型肺隱球菌病與肺癌的CT影像特征對比研究. 浙江醫學, 2020, 42(22): 2467-2469.
8. 陳倩, 胡恩德, 劉凱麗, 等. 孤立結節型肺隱球菌病與實性肺腺癌的CT鑒別診斷. 中國CT和MRI雜志, 2023, 21(1): 53-55.
9. 毛海霞, 韓砆石, 楊洋, 等. 孤立結節型肺隱球菌病與肺癌的 CT鑒別診斷. 中華臨床醫師雜志(電子版), 2014(17): 3083-3088.
10. 邢維明, 左玉強, 賈麗萍, 等. 孤立結節型肺隱球菌病與周圍型肺癌的CT比較. 齊魯醫學雜志, 2016, 31(2): 152-154, 158.
11. 趙澤鋼, 周新華, 呂巖, 等. 表現為孤立結節的原發性肺隱球菌病CT診斷及鑒別. 中國防癆雜志, 2016, 38(5): 358-363.
12. Zhao J, Sun L, Sun K, et al. Development and validation of a radiomics nomogram for differentiating pulmonary cryptococcosis and lung adenocarcinoma in solitary pulmonary solid nodule. Front Oncol, 2021, 11: 759840.
13. 仲艷, 王芬, 張騰, 等. 聯合CT影像組學和臨床影像特征在鑒別孤立性肺結節型肺隱球菌病與肺腺癌的應用價值. 影像診斷與介入放射學, 2022, 31(5): 335-339.
14. 谷雷, 文文, 賴國祥. 肺隱球菌病診治進展. 中華醫學雜志, 2020, 100(4): 317-320.
15. Hsiao PJ, Cheng H, Kao YH, et al. Comparison of laboratory diagnosis, clinical manifestation, and management of pulmonary cryptococcosis: report of the clinical scenario and literature review. Clin Chim Acta, 2022, 524: 78-83.
16. Hou X, Kou L, Han X, et al. Pulmonary cryptococcosis characteristics in immunocompetent patients-a 20-year clinical retrospective analysis in China. Mycoses, 2019, 62(10): 937-944.
17. Wu HH, Chen YX, Fang SY. Clinicopathological features of isolated pulmonary cryptococcosis in HIV-negative patients. J Int Med Res, 2020, 48(6): 300060520927877.
18. Wang T, Liu M, Zhang F. Clinical diagnosis, treatment, and laboratory detection of 50 cases of pulmonary cryptococcosis. Comput Math Methods Med, 2022, 2022: 7981472.
19. 蘭長青, 黃進寶, 黃梅萍, 等. 結節腫塊型肺隱球菌病CT特征分析. 中華放射學雜志, 2015, 49(10): 741-744.
20. Futatsuya T, Anzawa K, Mochizuki T, et al. Disseminated cutaneous cryptococcosis in an immunocompetent elderly long-term pigeon fancier. J Dermatol, 2020, 47(5): 551-553.
21. 魯興啟, 李躍興, 丁建平, 等. 免疫正常者實變型肺隱球菌病CT特點分析. 中國醫學科學院學報, 2021, 43(2): 216-221.
22. 石鋒, 楊維偉, 金威. 結節型肺隱球菌病CT影像學特征及鑒別價值. 中國CT和MRI雜志, 2021, 19(9): 54-56, 74.
23. 李靜, 陳正賢. 周圍型肺癌支氣管內超聲支氣管充氣征及其病理學基礎. 中國肺癌雜志, 2010, 13(5): 424-431.
24. Jiang J, Lv ZM, Lv FJ, et al. Clinical and computed tomography characteristics of solitary pulmonary nodules caused by fungi: a comparative study. Infect Drug Resist, 2022, 15: 6019-6028.
25. 周曉秋, 王寶春, 操嘯, 等. 多層螺旋CT征象對孤立性肺結節的診斷價值. 臨床肺科雜志, 2017, 22(12): 2270-2274.
26. Zhao HC, Xu QS, Shi YB, et al. Clinical-radiological predictive model in differential diagnosis of small (≤ 20 mm) solitary pulmonary nodules. BMC Pulm Med, 2021, 21(1): 281.
27. 江勇. 孤立性肺結節應用CT影像診斷的臨床價值. 影像研究與醫學應用, 2023, 7(7): 140-142.
28. Zhang Y, Chu Z, Yu J, et al. Computed tomography-based radiomics for identifying pulmonary cryptococcosis mimicking lung cancer. Med Phys, 2022, 49(9): 5943-5952.
29. Hu B, Xia W, Piao S, et al. A CT-based radiomics integrated model for discriminating pulmonary cryptococcosis granuloma from lung adenocarcinoma-a diagnostic test. Transl Lung Cancer Res, 2023, 12(8): 1790-1801.

West China Medical Journal

Comparison of CT characteristics between pulmonary cryptococcosis and lung cancer presenting as solitary nodules: a meta-analysis

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