Asian Pacific Journal of Cancer Prevention, Vol 10, 2009 335 Lung Cancer Misdiagnosed as Sputum Negative Tuberculosis Asian Pacific J Cancer Prev, 10, 335-338 Introduction World Health Organization (WHO) estimates, lung cancer (along with cancer of trachea and bronchus) to be the leading cause of mortality due to cancer in males in India. Smoking in women has markedly increased in the recent time. With increasing smoking behavior, lung cancer incidence is bound to grow. The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with either low dose computerized tomography (LDCT), chest x-ray (CXR), sputum cytology, or a combination of these tests. Early detection of lung cancer might not improve the survival but can provide better quality of life to the patient and increase chances of resection. India has a high prevalence of tuberculosis patients. Incidence of all form of tuberculosis in India is 168 per 100,000 per year and out of them 75 would be sputum smear positive for Acid fast bacilli (AFB) (WHO, 2008). Higher prevalence of tuberculosis and overlap of its clinical presentation with lung cancer creates a scenario where a significant number of early lung cancer patients may get wrongly labeled as TB (tuberculosis), more so in resource poor setup. This leads to a significant delay in diagnosis and management of lung cancer. We are Department of Medicine, All India Institute of Medical Sciences, New Delhi, Delhi-110029, India *For Correspondence: randeepguleria2002@yahoo.com Abstract Objective: To emphasize that delay in diagnosis of lung cancer can be caused by the wrong diagnosis of tuberculosis (TB) in TB endemic countries. This is of major concern as early-diagnosis of lung cancer can increase the chance of tumor resectability and timely chemo-radiotherapy may provide better quality of life. Methods: Proven lung cancer patients, who had received anti-tubercular treatment (ATT) since onset of current symptoms, were studied retrospectively during the period of Nov-07 to Nov-08. Data-source: Patient interview and medical records. Results: Total of 14 out of 70 patients received wrong diagnosis of TB and had received ATT [male-12, female-2; mean age-58.07±6.81; Non Small Cell Lung Cancer (NSCLC)-12, Small Cell Lung Cancer (SCLC)-2], 12 were smokers with median smoking pack-years of 44(15 to 112). Pre-referral sputum Acid fast Bacilli (AFB) was done in only 3 out of these 14 patients and sputum AFB was negative in these 3 patients. ATT was started on the basis of chest X-ray finding and clinical symptoms. Mean duration of ATT taken was 4.46±3.15 months. Conclusion: Due to high TB prevalence and radiological similarities, a large number of lung cancer patients initially get wrongly treated for TB. Also, clinicians associate lung cancer with high case-fatality and start ATT without detailed investigation. Altogether, this leads to delay in diagnosis and progression of disease. Key Words: Diagnostic errors - lung neoplasms - pulmonary tuberculosis. presenting this case series of lung cancer patients, as an attempt to quantify and emphasize the delay in diagnosis of lung cancer caused by wrong diagnosis of tuberculosis. Materials and Methods We registered 70 cases of lung cancer in our medicine department out patient clinic between Nov-2007 and Nov- 2008. As ours is a tertiary care referral hospital, most of the patients in this series were referred for evaluation of poor or no response to ATT and some for confirmation of diagnosis of lung cancer and further management. All the available records of the patients were analyzed and patients were interviewed for history of past treatment taken. The patient who do not have the tissue diagnosis were subjected for tissue sampling and patient who have the sampled tissue were subjected to review of slide by a senior pathologist from our institute. The data were subsequently analyzed. Results The demographic and clinical profile of the studied patients is given in Table 1. A total of 14 out of 70 (20%) patients had received ATT for varying durations since onset of chest symptoms. Mean (±SD) duration of ATT RESEARCH COMMUNICATION A Common Medical Error: Lung Cancer Misdiagnosed as Sputum Negative Tuberculosis Vikas Kumar Singh, Subhash Chandra, Sachin Kumar, Ghanshyam Pangtey, Anant Mohan, Randeep Guleria*