ABSTRACT
BACKGROUND: The final diagnosis of COVID-19 pneumonia relies on a clinical and radiological picture, along with SARS-CoV2 RNAdetection in the oral and nasal-pharyngeal swab. The latter, has a high rate of false negative results, even in presence of symptoms and radiological abnormalities suggestive for COVID-19. In case of an atypical or indeterminate radiological pattern, the need of excluding COVID-19 and ruling out other differential diagnoses would be necessary. In such settings, the role of invasive procedures for obtaining samples from the lower respiratory tract such flexible bronchoscopy has been debated, due to the risk of contagion. The aim of this study was to evaluate the role of flexible bronchoscopy with bronchial washing during the pandemic of COVID-19. We aimed to define the value of bronchial washing in patients with an atypical or indeterminate chest CT-scan pattern for viral pneumonia. METHODS: We retrospectively reviewed patients with an atypical or indeterminate CTscan pattern for COVID-19 pneumonia and a negative test for SARS-CoV2 RNAon oral/ nasal-pharyngeal swabs, who underwent bronchoscopy for bronchial washings to exclude or confirm the diagnosis of SARS-CoV2 pneumonia. RESULTS: Among the 44 patients included with an atypical or indeterminate chest CT-scan pattern for COVID-19 pneumonia, no SARS-CoV2 RNAwas detected in the bronchial washing. CONCLUSIONS: The role of bronchoscopy in the diagnosis of COVID-19 pneumonia is negligible in indeterminate or atypical patterns on chest CT scan. However, we should not shy away from these invasive procedures in these profiles of cases to exclude bronchoscopically diagnosed differential diagnoses like other infections and non-infectious causes.
ABSTRACT
INTRODUCTION: COVID-19 has disrupted the global health care system since March 2020. Lung cancer (LC) patients (pts) represent a vulnerable population highly affected by the pandemic. This multicenter Italian study aimed to evaluate whether the COVID-19 outbreak had an impact on access to cancer diagnosis and treatment of LC pts compared with pre-pandemic time. METHODS: Consecutive newly diagnosed LC pts referred to 25 Italian Oncology Departments between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset and diagnostic and therapeutic services were compared with the same period in 2019. Differences between the 2 years were analyzed using the chi-square test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS: A slight reduction (-6.9%) in newly diagnosed LC cases was observed in 2020 compared with 2019 (1523 versus 1637, P = 0.09). Newly diagnosed LC pts in 2020 were more likely to be diagnosed with stage IV disease (P < 0.01) and to be current smokers (someone who has smoked more than 100 cigarettes, including hand-rolled cigarettes, cigars, cigarillos, in their lifetime and has smoked in the last 28 days) (P < 0.01). The drop in terms of new diagnoses was greater in the lockdown period (percentage drop -12% versus -3.2%) compared with the other months included. More LC pts were referred to a low/medium volume hospital in 2020 compared with 2019 (P = 0.01). No differences emerged in terms of interval between symptoms onset and radiological diagnosis (P = 0.94), symptoms onset and cytohistological diagnosis (P = 0.92), symptoms onset and treatment start (P = 0.40), and treatment start and first radiological revaluation (P = 0.36). CONCLUSIONS: Our study pointed out a reduction of new diagnoses with a shift towards higher stage at diagnosis for LC pts in 2020. Despite this, the measures adopted by Italian Oncology Departments ensured the maintenance of the diagnostic-therapeutic pathways of LC pts.