A Retrospective Cross-sectional Study of High-Resolution Computed tomography Thorax Manifestations in Cancer Patients Suspected to Have Coronavirus Disease 2019 Infection
Abhijeet Sugriv Ghodke, Sushil Kachewar, Divya JadhavAbstract
Background:
The novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system, producing lung findings — notably ground-glass opacities (GGOs) — on high-resolution computed tomography (HRCT) that closely mimic those seen in malignancy-related pulmonary lesions. Cancer patients, owing to their immunocompromised state, are particularly susceptible to COVID-19 infection and carry a worse prognosis. This overlap in radiological findings between COVID-19 pneumonia and malignancy-associated pulmonary changes poses a significant diagnostic challenge, risking misdiagnosis and delayed management.
Aims and Objectives:
To study the role of HRCT Thorax in the identification and evaluation of typical manifestations of suspected COVID-19 infection in patients with preexisting malignancies. To identify atypical HRCT features of suspected COVID-19 infection in patients with preexisting malignancies.
Materials and Methods:
This retrospective cross-sectional study was conducted between August 2020 and February 2021 in the CT section of the Department of Radio-diagnosis at a tertiary care hospital. A total of 100 patients satisfying the inclusion-exclusion criteria, referred for HRCT Thorax with suspected COVID-19 infection and having preexisting malignancies, were enrolled. Categorical variables were presented as number and percentage, and continuous variables as mean ± standard deviation and median. Data were visualized using bar diagrams and pie diagrams.
Results:
The study included 56 female and 44 male patients; 64% were RT-PCR positive and 36% negative. Mean age was 55 ± 13.3 years (range: 24–70 years). The most common malignancy was breast cancer, followed by lung and cervical cancer; 5 patients had a history of pulmonary metastasis. The predominant HRCT pattern was GGOs (78%), typically asymmetrical, peripheral, bilateral, and subpleural with lower lobe predilection. Consolidation concurrent with GGO was found in 33%, and sole patchy consolidation in 7%. Pleural effusion was present in 34%. Additional atypical findings included bronchiectasis (32%), lymphadenopathy (27%), crazy paving (22%), vascular changes (19%), and reticular opacities (17%). CT severity scoring showed 22% score 0, 30% mild (1–8), 32% moderate (9–15), and 16% severe (>15). The overall 30-day mortality was 22%, predominantly in lung cancer (25%), followed by oral cancer (18%). Disease severity was more pronounced in males.
Conclusion:
HRCT Thorax is a valuable diagnostic tool in cancer patients suspected of COVID-19 infection, demonstrating both typical findings (bilateral subpleural GGOs, lower lobe predilection) and atypical findings (consolidation, pleural effusion, lymphadenopathy, fibrotic changes) more prevalent in oncological patients. A CT severity score >8 in oncological patients can serve as a severity predictor to guide hospitalization and management decisions.