SARS-CoV-2 Detection on Bronchoalveolar Lavage: An Italian Multicenter experience

Abstract

<b><i>Background:</i></b> Bronchoscopy with bronchoalveolar lavage (BAL) during the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) pandemic should be reserved to a limited number of clinical indications. The yield of BAL for the diagnosis of suspected or confirmed pulmonary SARS-CoV-2 infection is still unknown. <b><i>Objectives:</i></b> We aimed to evaluate the diagnostic ratio of BAL in detecting SARS-CoV-2 pulmonary infection in patients undergoing bronchoscopy for different indications as well as describe the clinical, radiological, and endoscopic characteristics of patients with SARS-CoV-2 on BAL. <b><i>Method:</i></b> We conducted a multicenter retrospective study including all patients who underwent bronchoscopy for the detection of SARS-CoV-2 on BAL. Clinical, computed tomography (CT), endoscopic, and microbiologic data were gathered from March 16th to May 27th, 2020. <b><i>Results:</i></b> 131 patients were included. Bronchoscopy was performed for suspected SARS-CoV-2 infection (65.5%), alternative diagnosis (12.9%), suspected superinfections (19.8%), and lung atelectasis (1.5%). SARS-CoV-2 was isolated on BAL 43 times (32.8%) and the highest isolation rate was in patients with suspected SARS-CoV-2 infection (74.4%); 76% of positive patients had a double-negative nasopharyngeal swab. Peripheral, posterior and multilobar CT opacities were more frequent in SARS-CoV-2 patients, and the number of CT findings was higher in positive patients, particularly those with suspected SARS-CoV-2 infection. We recorded a progressive reduction of SARS-CoV-2 isolation during the observation period. <b><i>Conclusions:</i></b> In our centers, the rate of detection of SARS-CoV-2 on BAL in patients with suspected infection was 37.2%. The agreement of BAL with nasopharyngeal swabs was high; CT alterations could predict the pretest probability of SARS-CoV-2 infection, but suspicion of viral infection should be always considered.

COVID-19 Diagnosis in Case of Two Negative Nasopharyngeal Swabs: Association between Chest CT and Bronchoalveolar Lavage Results

“…Information obtained from the bronchoscopy were noted, as well as the main chest CT features. This paper differs from the previous one [6] for methodological evaluation of CT scans: in particular, each patient's CT scan was evaluated in consensus by two expert radiologists and for each case the likelihood of COVID-19 pneumonia was reported, based on STR/RSNA and CO-RADS standards [2,3]. The two readers acquired their COVID-19 experience participating in a previous study [4] where they reviewed in consensus 773 CTs for suspected SARS-CoV-2 infection.…”

“…We conducted a retrospective single-center study approved by the institutional committee on human research (protocol number, CE 97/20). Patients included in the current study are part of a previously published study ( 6 ). We included all the consecutive patients from March 16 to May 19, 2020, who underwent a chest CT scan after two consecutive negative nasopharyngeal swabs and followed by bronchoscopy with BAL with RT-PCR testing for SARS-CoV-2 RNA.…”

“…Information obtained from the bronchoscopy were noted, as well as the main chest CT features ( Fig ). This research letter differs from the previous article ( 6 ) for methodologic evaluation of CT scans: In particular, each patient’s CT scan was evaluated in consensus by two expert radiologists (Z.F., A.P.) and for each case, the likelihood of COVID-19 pneumonia was reported based on STR/RSNA and CO-RADS standards ( 2 , 3 ).…”

Bronchoscopy in COVID19 ARDS patients on mechanical ventilation – a prospective study

“…(6) Patrucco et al reported that of the 120 patients with 2 negative swabs, SARS-CoV-2 was isolated (27.5%) on BAL. (9)…”

False-Negative Nasopharyngeal Swabs and Positive Bronchoalveolar Lavage: Implications for Chest CT in Diagnosis of COVID-19 Pneumonia

“…Patrucco and colleagues ( 3 ) present a single-center retrospective study of the diagnostic performance of chest CT in patients suspected of having COVID-19 pneumonia, an imaging analysis of a subset of patients from a recently published study of 131 patients tested by using BAL for SARS-CoV-2 ( 7 ). They evaluated 46 patients who underwent a chest CT examination after two consecutive negative nasopharyngeal swab PCRs, using BAL an average of 1–2 days after the upper respiratory tract swabs as the reference standard ( 3 ).…”