Chest CT scans are frequently abnormal in asymptomatic patients with newly diagnosed acute myeloid leukemia

Abstract

Chest computed tomography (CT) findings of nodules, ground glass opacities, and consolidations are often interpreted as representing invasive fungal infection in individuals with febrile neutropenia. We assessed whether these CT findings were present in asymptomatic individuals with acute myeloid leukemia (AML) at low risk of invasive fungal disease. A retrospective study of consecutive asymptomatic adult patients with newly diagnosed AML over a 2-year period was performed at a tertiary care oncology center. Radiology reports of baseline chest CTs were reviewed. Of 145 CT scans, the majority (88%) had pulmonary abnormalities. Many (70%) had one or both of unspecified opacities (52%) and nodules (49%). Ground glass opacities (18%) and consolidations (12%) occurred less frequently. Radiologists suggested pneumonia as a possible diagnosis in 32% (n = 47) of scans. Chest CT may result in over-diagnosis of invasive fungal disease in individuals with febrile neutropenia if interpreted without correlation to the patients' clinical status.

Cell‐free DNA next‐generation sequencing successfully detects infectious pathogens in pediatric oncology and hematopoietic stem cell transplant patients at risk for invasive fungal disease

“…Interestingly, of the 11 patients with possible IFD due to abnormal chest CT results, none had fungi detected by cfDNA NGS and nine (82%) of these patients received antifungal therapy for >1 week. While certain radiographic findings can be suggestive of IFD, an image‐guided diagnostic approach is often nonspecific and can lead to overdiagnosis of IFD in febrile neutropenic patients . Comparing abnormal imaging results to a noninvasive reliable blood test might help establish fungal pathogens as the causal agents.…”

“…Specifically, the GM test has a positive predictive value of 0–100% and negative predictive value of 70–100%, and the BG test has a positive predictive value of 17–49% and negative predictive value of 84–96% . Radiographic findings are used to aid diagnosis of fungal pulmonary pathology in the setting of fever and neutropenia (FN), but are notably nonspecific, result in overdiagnosis, and cannot accurately detect a specific fungal pathogen to best guide treatment . PCR‐based technologies are a promising approach to compliment current methods, but false‐positive and ‐negative results continue to impede widespread applicability .…”