Development and Validation of a Scoring System for Differential Diagnosis of Tuberculosis and Metastatic Tumor in the Spine
Open Access
- 1 February 2021
- journal article
- research article
- Published by Taylor & Francis Ltd in Infection and Drug Resistance
- Vol. ume 14, 407-413
- https://doi.org/10.2147/idr.s298316
Abstract
Purpose: Spinal tuberculosis (TB) and metastatic tumor (MT) are common diseases with similar manifestations. Although pathological evaluation is the gold standard to confirm diagnosis, performing biopsies in all patients is not feasible. This study is aimed to create a scoring system to facilitate the differential diagnosis of spinal TB and MT before invasive procedures. Methods: Altogether, 447 patients with spinal TB (n=198) and MT (n=249) were retrospectively analyzed. Patients were randomly assigned at 2:1 ratio to a training cohort and a validation cohort. Clinical, laboratory, and radiological diagnostic factors were identified by χ2 and multiple logistic regression analyses. The scoring system was then established based on the identified independent diagnostic factors scored by regression coefficient β value, with the cut-off value being determined by ROC curve. The sensitivity and specificity of the system was calculated by comparing the predicted diagnosis with their actual pathological diagnosis. Results: This scoring system was composed of 5 items: pain worsens at night (0 or 2 points), CRP value (0 or 3 points), tumor marker values (0 or 2 points), skip lesions (0 or 3 points), and intervertebral space destruction (0 or 3 points). Patients scoring higher than 7.5 could be diagnosed as spinal TB, otherwise, MT. According to the internal validation, the sensitivity and specificity of the system were 87.9% and 91.6%, respectively. Conclusion: This study established and validated a scoring system which could be used to differentiate spinal TB from MT, thus helping clinicians in quick and accurate differential diagnosis.Keywords
This publication has 23 references indexed in Scilit:
- A case of atypical spinal tuberculosis mimicking metastatic tumorThe Spine Journal, 2015
- Neurological Recovery Determined by C-Reactive Protein, Erythrocyte Sedimentation Rate and Two Different Posterior Decompressive Surgical Procedures: A Retrospective Clinical Study of Patients with Spinal Tuberculosis.2015
- Differentiation of tuberculosis and metastatic cancer in the spine using dynamic contrast-enhanced MRIEuropean Spine Journal, 2015
- Isolated atypical spinal tuberculosis mistaken for neoplasia: case report and literature reviewEuropean Spine Journal, 2012
- Spinal tuberculosis: A reviewThe Journal of Spinal Cord Medicine, 2011
- Imaging Presentation Highly Manifested as Tuberculosis in a Case of Spinal Metastatic CarcinomaOrthopedics, 2011
- Tuberculosis of the spineThe Journal of Bone and Joint Surgery. British volume, 2010
- The Usefulness of CT Perfusion in Differentiation between Neoplastic and Tuberculous Disease of the SpineJournal of Neuroimaging, 2009
- A fatal case of spinal tuberculosis mistaken for metastatic lung cancer: recalling ancient Pott's diseaseAnnals of Clinical Microbiology and Antimicrobials, 2009
- A simple C-reactive protein measurement for the differentiation between tuberculous and malignant pleural effusionRespirology, 2004