COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study

Abstract

Background: Radiological manifestations of coronavirus disease 2019 (COVID-19) featured ground-glass opacities (GGOs), especially in the early stage, which might create confusion in differential diagnosis with early lung cancer. We aimed to specify the radiological characteristics of COVID-19 and early lung cancer and to unveil the discrepancy between them.Methods: One hundred and fifty-seven COVID-19 patients and 374 early lung cancer patients from four hospitals in China were retrospectively enrolled. Epidemiological, clinical, radiological, and pathological characteristics were compared between the two groups using propensity score-matched (PSM) analysis.Results: COVID-19 patients had more distinct symptoms, tended to be younger (P<0.0001), male (P<0.0001), and had a higher body mass index (P=0.014). After 1:1 PSM, 121 matched pairs were identified.Regarding radiological characteristics, patients with a single lesion accounted for 17% in COVID-19 and 89% in lung cancer (P<0.0001). Most lesions were peripherally found in both groups. Lesions in COVID-19 involved more lobes (median 3.5 vs. 1; P<0.0001) and segments (median 6 vs. 1; P<0.0001) and tended to have multiple types (67%) with patchy form (54%). Early lung cancer was more likely to have a single type (92%) with oval form (66%). Also, COVID-19 and early lung cancer either had some distinctive features on computed tomography (CT) images.Conclusions: Both COVID-19 and early lung cancers showed GGOs, with similar but independent features. The imaging characteristics should be fully understood and combined with epidemiological

COVID-19 and the multidisciplinary care of patients with lung cancer: an evidence-based review and commentary

“…Postoperative COVID-19 was associated with an increased rate of readmission (50 vs. 5%, p = 0.004), but no difference in 30-day morbidity (for the study group: grade 2, 24%; grade 3, 7%; grade 4, 1%) or mortality ( n = 1 COVID negative patient, 0.9%). Immediate oncological outcomes did not differ significantly between groups (R0 resection 99%, nodal upstaging 14%, adjuvant treatment 29%) Zhang et al 81 COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study China Retrospective cohort study 531 patients • 157 patients with COVID-19 • 374 patients with early lung cancer Secondary care • Epidemiological characteristics • Clinical characteristics • Radiological characteristics • Pathological characteristics Lesions in COVID-19 involved more lobes and segments (median 6 vs. 1; p < 0.0001) and tended to have multiple types (67%) with patchy form (54%). In most cases, a treatment delay was requested by the patient, suggesting that lung cancer patients had more COVID‐19‐related anxiety than expected.…”

Management and Thinking on the Treatment of Cancer Patients During the COVID-19

“…Secondly, most COVID-19 patients have more than one type of lung lesion, while lung cancer patients tend to have either pure GGO or mixed GGO. What is more, COVID-19 shows more patchy lesions, while lung cancer shows more oval lesions (Zhang Y. J. et al, 2020; Table 1). There are many types of lung cancer that various imaging manifestations may reveal, therefore, we need to use RT-PCR and next-generation sequencing methods applied to respiratory tract specimens to assist identification when necessary.…”

“…Most cases of COVID-19 showed bilateral parenchymal ground-glass opacity (GGO) or consolidative pulmonary opacity on CT scans, and the enlargement and consolidation of GGO usually indicate the progression of COVID-19 (Chung et al, 2020). The characteristics of COVID-19 also include reticular pattern, linear subpleural opacity, bronchial dilatation, centrilobular nodules and tree-in-bud (Zhang Y. J. et al, 2020). Through the imaging performance of CT, we can distinguish lung cancer from COVID-19 through the following points.…”

The Impact of COVID-19 on Cancer

“… 28 Furthermore, ground-glass opacity is the most common CT manifestation of COVID-19, especially in the early stage, which may cause confusion with the diagnosis of early lung cancer. 29 In addition, because antiviral therapy disrupts the conventional treatment and the regular follow-up of cancer patients, the proportion of patients with advanced disease has increased. Therefore, the COVID-19 epidemic has delayed the diagnosis and treatment of cancer.…”