Timely Diagnosis and Treatment Shortens the Time to Resolution of Coronavirus Disease (COVID-19) Pneumonia and Lowers the Highest and Last CT Scores From Sequential Chest CT

Huang, Guoquan; Gong, Tao; Wang, Guangbin; Wang, Jianwen; Guo, Xinfu; Erpeng, Cai; Liu, Shirong; Li, Xiaohu; Yu, Yongqiang; Lin, Liangjie

doi:10.2214/ajr.20.23078

Cited by 96 publications

(110 citation statements)

References 7 publications

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“…Whenever available, CT images were centrally reviewed by two senior radiologists with consensus qualitative and semiquantitative assessment. In accordance with previous reports on COVID-19 imaging [7,8], the following patterns were sought: ground-glass opacity, crazy paving (ground-glass opacity associated with interlobular septal thickening [9]), focal consolidation, and linear consolidation. To be included in the COVID-19 population, patients with negative or not available RNA test had to display typical and newly acquired (i.e., not pre-existing on the previous CT scan) COVID-19-related lung lesions.…”

Section: Ct Scan Protocol and Image Interpretationmentioning

confidence: 94%

COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

et al. 2020

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Background: Cancer patients have been reported to be at higher risk of COVID-19 complications and deaths. We report the characteristics and outcome of patients diagnosed with COVID-19 during breast cancer treatment at Institut Curie hospitals (ICH, Paris area, France). Methods: An IRB-approved prospective registry was set up at ICH on March 13, 2020, for all breast cancer patients with COVID-19 symptoms or radiologic signs. Registered data included patient history, tumor characteristics and treatments, COVID-19 symptoms, radiological features, and outcome. Data extraction was done on April 25, 2020. COVID-19 patients were defined as those with either a positive RNA test or typical, newly appeared lung CT scan abnormalities. Results: Among 15,600 patients actively treated for early or metastatic breast cancer during the last 4 months at ICH, 76 patients with suspected COVID-19 infection were included in the registry and followed. Fifty-nine of these patients were diagnosed with COVID-19 based on viral RNA testing (N = 41) or typical radiologic signs: 37/59 (63%) COVID-19 patients were treated for metastatic breast cancer, and 13/59 (22%) of them were taking corticosteroids daily. Common clinical features mostly consisted of fever and/or cough, while ground-glass opacities were the most common radiologic sign at diagnosis. We found no association between prior radiation therapy fields or extent of radiation therapy sequelae and extent of COVID-19 lung lesions. Twenty-eight of these 59 patients (47%) were hospitalized, and 6 (10%) were transferred to an intensive care unit. At the time of analysis, 45/59 (76%) patients were recovering or had been cured, 10/59 (17%) were still followed, and 4/59 (7%) had died from COVID-19. All 4 patients who died had significant non-cancer comorbidities. In univariate analysis, hypertension and age (> 70) were the two factors associated with a higher risk of intensive care unit admission and/or death.

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Section: Ct Scan Protocol and Image Interpretationmentioning

confidence: 94%

COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

et al. 2020

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“…The mean or median age of patients ranged from 3 to 70 years. Twelve studies were from Wuhan, China (3,23,25,26,29,36,49,51,61,71,75,77). Correlations were observed between disease severity and the proportion of patients with comorbidities (Spearman's ρ = 0.53; p = 0.003) and between disease severity and the proportion of elderly patients I n P r e s s (Spearman's ρ = 0.52; p = 0.01).…”

Section: Study Characteristicsmentioning

confidence: 99%

Diagnostic Performance of CT and Reverse Transcriptase Polymerase Chain Reaction for Coronavirus Disease 2019: A Meta-Analysis

2020

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statement: Chest computed tomography scans for the primary screening or diagnosis of coronavirus disease 2019 would not be beneficial in a low-prevalence region due to the substantial rate of false-positives.This copy is for personal use only. To order printed copies, contact reprints@rsna.org I n P r e s s Key Results• The pooled sensitivity and specificity were 94% (95% CI: 91%, 96%) and 37% (95% CI: 26%, 50%), respectively, for chest CT. The pooled sensitivity of reverse transcriptasepolymerase chain reaction (RT-PCR) was 89% (95% CI: 81%, 94%).• In low-prevalence (<10%) countries, the positive predictive value of RT-PCR (range: 47.3%, 84.3%) was more than ten times higher than that of CT scans (range: 1.5%, 8.3%).The negative predictive value of both methods ranged from 99.0% to 99.9%. AbbreviationsCI = confidence interval, COVID-19 = coronavirus disease 2019, NPV = negative predictive value, ORF = open reading frame, PPV = positive predictive value, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-analyses, QUADAS-2 = Quality Assessment of Diagnostic Accuracy Studies-2, RT-PCR = reverse transcriptase-polymerase chain reaction, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, WHO = World Health Organization I n P r e s s Abstract Background: Recent studies have suggested that chest computed tomography (CT) scans could be used as a primary screening or diagnostic tool for coronavirus disease 2019 (COVID-19) in epidemic areas.Purpose: To perform a meta-analysis to evaluate diagnostic performance measures, including predictive values, of chest CT and initial reverse transcriptase-polymerase chain reaction (RT-PCR). studies on COVID-19 that reported the sensitivity and/or specificity of CT scans and/or RT-PCR assays. The pooled sensitivity and specificity were estimated by using random-effects models. The actual prevalence (i.e., the proportion of confirmed patients among those tested) in eight countries was obtained from web sources, and the predictive values were calculated. Meta-regression was performed to reveal the effect of potential explanatory factors on the diagnostic performance measures. Results:The pooled sensitivity was 94% (95% CI: 91%, 96%; I 2 =95%) for chest CT and 89% (95% CI: 81%, 94%; I 2 =90%) for RT-PCR. The pooled specificity was 37% (95% CI: 26%, 50%; I 2 =83%) for chest CT. The prevalence of COVID-19 outside China ranged from 1.0% to 22.9%. For chest CT scans, the positive predictive value (PPV) ranged from 1.5% to 30.7%, and the negative predictive value (NPV) ranged from 95.4% to 99.8%. For RT-PCR, the PPV ranged from 47.3% to 96.4%, while the NPV ranged from 96.8% to 99.9%. The sensitivity of CT was affected by the distribution of disease severity, the proportion of patients with comorbidities, and the proportion of asymptomatic patients (all p < 0.05). The sensitivity of RT-PCR was negatively associated with the proportion of elderly patients (p = 0.01). Conclusion:Outside of China where there is a low-prevalence of COVID-19 (1-22.9%), chest CT screening...

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“…previous reports on COVID-19 imaging [14,15], the following patterns were sought: ground-glass opacity, crazy paving (ground glass opacity associated with interlobular septal thickening [16]), focal consolidation and linear consolidation. To be included in the COVID-19 population, patients with negative or not available RNA test had to display typical and newly acquired (i.e.…”

Section: Registrymentioning

confidence: 99%

COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

Vuagnat

Frélaut

Ramtohul

et al. 2020

Preprint

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Background: Cancer patients have been reported to be at higher risk of COVID-19 complications and deaths. We report the characteristics and outcome of patients diagnosed with COVID-19 during breast cancer treatment at Institut Curie hospitals (ICH, Paris area, France).Methods: An IRB-approved prospective registry was set up at ICH on March 13 th , 2020 for all breast cancer patients with COVID-19 symptoms or radiologic signs. Registered data included patient history, tumor characteristics and treatments, COVID-19 symptoms, radiological features and outcome. Data extraction was done on April 25 th , 2020. COVID-19 patients were defined as those with either a positive RNA test or typical, newly appeared lung CT-scan abnormalities.Results: Among 15,600 patients actively treated for early or metastatic breast cancer during the last 4 months at ICH, 76 patients with suspected COVID-19 infection were included in the registry and followed.Fifty-nine of these patients were diagnosed with COVID-19 based on viral RNA testing (N=41) or typical radiologic signs: 37/59 (63%) COVID-19 patients were treated for metastatic breast cancer, and 13/59 (22%) of them were taking corticosteroids daily. Common clinical features mostly consisted of fever and/or cough, while ground-glass opacities were the most common radiologic sign at diagnosis. We found no association between prior radiation therapy fields or extent of radiation therapy sequelae and extent of COVID-19 lung lesions. Twenty-eight of these 59 patients (47%) were hospitalized and 6 (10%) were transferred to an intensive care unit. At the time of analysis, 45/59 (76%) patients were recovering or had been cured, 10/59 (17%) were still followed and 4/59 (7%) had died from COVID-19. All 4 patients who died had significant non-cancer comorbidities. In univariate analysis, hypertension and age (>70) were the two factors associated with a higher risk of intensive care unit admission and/or death. Conclusions:This prospective registry analysis suggests that the COVID-19 mortality rate in breast cancer patients depends more on comorbidities than prior radiation therapy or current anti-cancer treatment. Special attention must be paid to comorbidities when estimating the risk of severe COVID-19 in breast cancer patients.All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

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Timely Diagnosis and Treatment Shortens the Time to Resolution of Coronavirus Disease (COVID-19) Pneumonia and Lowers the Highest and Last CT Scores From Sequential Chest CT

Cited by 96 publications

References 7 publications

COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

Diagnostic Performance of CT and Reverse Transcriptase Polymerase Chain Reaction for Coronavirus Disease 2019: A Meta-Analysis

COVID-19 in breast cancer patients: a cohort at the Institut Curie hospitals in the Paris area

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