tetano
Editor, Senior Moderator
J Infect Dis
. 2023 Nov 20:jiad272.
doi: 10.1093/infdis/jiad272. Online ahead of print. Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients With Cancer
Alexander Franklin[SUP] 1 2 [/SUP], Teny M John[SUP] 1 [/SUP], Fareed Khawaja[SUP] 1 [/SUP], Ying Jiang[SUP] 1 [/SUP], Eduardo Yepez[SUP] 1 [/SUP], Jitesh Ahuja[SUP] 3 [/SUP], Saadia A Faiz[SUP] 4 [/SUP], Lara Bashoura[SUP] 4 [/SUP], Ajay Sheshadri[SUP] 4 [/SUP], Vickie R Shannon[SUP] 4 [/SUP], Diwakar D Balachandran[SUP] 4 [/SUP], Kelly McConn[SUP] 1 [/SUP]; Data-Driven Determinants for COVID-19 Oncology Discovery Effort Team; Victor E Mulanovich[SUP] 1 [/SUP], Micah Bhatti[SUP] 5 [/SUP], Roy F Chemaly[SUP] 1 [/SUP]
Affiliations
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) on nasopharyngeal swab (NPS), remains the most reliable and practical test to diagnose coronavirus disease 2019 (COVID-19). Current literature is sparse regarding the rates of discordance between NPS and bronchoalveolar lavage (BAL) in patients with cancer.
Methods: We conducted a retrospective cohort study of adult patients with cancer who had BAL samples tested for SARS-CoV-2 at a comprehensive cancer center. Patients without NPS PCR for SARS-CoV-2 before BAL were excluded.
Results: In a cohort of 345 patients, 12% and 17% tested positive for SARS-CoV-2 on NPS and BAL, respectively. There was a 6.3% NPS-/BAL+ discordance rate and a 9.5% NPS+/BAL- discordance rate. Patients with lymphoma (adjusted odds ratio [aOR] = 4.06; P = .007) and Hispanic patients (aOR = 3.76; P = .009) were more likely to have NPS-/BAL+ discordance on multivariate analysis. Among patients with NPS- /BAL- for SARS-CoV-2, an alternate infectious (23%) and a noninfectious etiology (16%) were identified in BAL.
Conclusions: Our discordance rates between NPS and BAL were sufficient to recommend BAL in certain patients with cancer with a high clinical suspicion of COVID-19. BAL has value in identifying alternative etiologies of illness in patients with suspected or confirmed COVID-19.
Keywords: COVID-19; PCR; bronchoalveolar lavage; cancer; diagnostics; oncologic.
. 2023 Nov 20:jiad272.
doi: 10.1093/infdis/jiad272. Online ahead of print. Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients With Cancer
Alexander Franklin[SUP] 1 2 [/SUP], Teny M John[SUP] 1 [/SUP], Fareed Khawaja[SUP] 1 [/SUP], Ying Jiang[SUP] 1 [/SUP], Eduardo Yepez[SUP] 1 [/SUP], Jitesh Ahuja[SUP] 3 [/SUP], Saadia A Faiz[SUP] 4 [/SUP], Lara Bashoura[SUP] 4 [/SUP], Ajay Sheshadri[SUP] 4 [/SUP], Vickie R Shannon[SUP] 4 [/SUP], Diwakar D Balachandran[SUP] 4 [/SUP], Kelly McConn[SUP] 1 [/SUP]; Data-Driven Determinants for COVID-19 Oncology Discovery Effort Team; Victor E Mulanovich[SUP] 1 [/SUP], Micah Bhatti[SUP] 5 [/SUP], Roy F Chemaly[SUP] 1 [/SUP]
Affiliations
- PMID: 37983000
- DOI: 10.1093/infdis/jiad272
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) on nasopharyngeal swab (NPS), remains the most reliable and practical test to diagnose coronavirus disease 2019 (COVID-19). Current literature is sparse regarding the rates of discordance between NPS and bronchoalveolar lavage (BAL) in patients with cancer.
Methods: We conducted a retrospective cohort study of adult patients with cancer who had BAL samples tested for SARS-CoV-2 at a comprehensive cancer center. Patients without NPS PCR for SARS-CoV-2 before BAL were excluded.
Results: In a cohort of 345 patients, 12% and 17% tested positive for SARS-CoV-2 on NPS and BAL, respectively. There was a 6.3% NPS-/BAL+ discordance rate and a 9.5% NPS+/BAL- discordance rate. Patients with lymphoma (adjusted odds ratio [aOR] = 4.06; P = .007) and Hispanic patients (aOR = 3.76; P = .009) were more likely to have NPS-/BAL+ discordance on multivariate analysis. Among patients with NPS- /BAL- for SARS-CoV-2, an alternate infectious (23%) and a noninfectious etiology (16%) were identified in BAL.
Conclusions: Our discordance rates between NPS and BAL were sufficient to recommend BAL in certain patients with cancer with a high clinical suspicion of COVID-19. BAL has value in identifying alternative etiologies of illness in patients with suspected or confirmed COVID-19.
Keywords: COVID-19; PCR; bronchoalveolar lavage; cancer; diagnostics; oncologic.