COVID-19 Pneumonia and Lung Cancer: A Challenge for the Radiologist Review of the Main Radiological Features, Differential Diagnosis and Overlapping Pathologies

Abstract

The COVID-19 pneumonia pandemic represents the most severe health emergency of the 21st century and has been monopolizing health systems’ economic and human resources world-wide. Cancer patients have been suffering from the health systems’ COVID-19 priority management with evidence of late diagnosis leading to patients’ poor prognosis and late medical treatment. The radiologist plays a pivotal role as CT represents a non-invasive radiological technique which may help to identify possible overlap and differential diagnosis between COVID-19 pneumonia and lung cancer, which represents the most frequent cancer histology in COVID-19 patients. Our aims are: to present the main CT features of COVID-19 pneumonia; to provide the main differential diagnosis with lung cancer, chemotherapy-, immunotherapy-, and radiotherapy-induced lung disease; and to suggest practical tips and key radiological elements to identify possible overlap between COVID-19 pneumonia and lung cancer. Despite similarities or overlapping findings, the combination of clinics and some specific radiological findings, which are also identified by comparison with previous and follow-up CT scans, may guide differential diagnosis. It is crucial to search for typical COVID-19 pneumonia phase progression and typical radiological features on HRTC. The evidence of atypical findings such as lymphadenopathies and mediastinal and vessel invasion, as well as the absence of response to therapy, should arouse the suspicion of lung cancer and require contrast administration. Ground-glass areas and/or consolidations bound to radiotherapy fields or pneumonitis arising during and after oncological therapy should always arouse the suspicion of radiation-induced lung disease and chemo/immunotherapy-induced lung disease. The radiological elements we suggest for COVID-19 and lung cancer differential diagnosis may be used to develop AI protocols to guarantee an early and proper diagnosis and treatment to improve patients’ quality of life and life expectancy.

Outcomes of Thoracoscopic Lobectomy after Recent COVID-19 Infection

“…In the initial phases of the pandemic, the accessibility to diagnostic and therapeutic pathways was impaired due to the conversion of several departments into COVID-19 units, causing disruptions to oncological screening, treatment, and surveillance [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Additionally, COVID-19 infection can cause serious complications in oncological patients undergoing chemotherapy or recovering from recent surgery [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Dynamic change of COVID-19 lung infection evaluated using co-registration of serial chest CT images

“…Since CT can detect small areas of GGO (23), it is a promising imaging tool for longitudinal monitoring of the disease. Several studies have applied serial CT to assess the evolution of the COVID-19 lesions during the disease (24)(25)(26). Only qualitative evaluation was performed, e.g., by using a scoring system of 0-5 in each of 5 lobes in the lung, with a total score of 0-25.…”

Immune Checkpoint Inhibitors and Tuberculosis Infection in Lung Cancer: A Case Series and Systematic Review With Pooled Analysis

“…Patients with lung cancer coexisting with TB infection usually present with cough, expectoration, and other non-specific symptoms, such as fever and weight loss, which are easily confused with the manifestations of cancer itself and pneumonia of other etiologies. 16,25,26 Our results showed that new consolidation, patchy opacity/nodules, or tree-in-bud sign is manifested in chest computed tomography (CT) or Xray imaging for patients with lung cancer coexisting with TB infection during ICI treatment. Therefore, if new radiological lesions appear in patients with lung cancer during ICI treatment, the nature of the lesions should be clarified.…”