Retrospective Analysis of Chest CT Imaging Findings of COVID-19 in Cancer Patients: Initial Experience in a Tertiary Cancer Center

Purpose: To assess the diagnostic value of initial chest CT findings and the CT-based severity scoring system to predict the clinical outcome of COVID-19 in cancer patients. Materials and Methods: Between March 1st and May 15th 2020, we included all consecutive cancer patients (with hematological or solid malignancy) with clinical suspicion of COVID-19, or asymptomatic patients admitted for cancer treatment and screened for COVID-19. Diagnostic performance of chest CT for diagnosis and disease severity assessment was evaluated. Disease severity was evaluated based on the SFR (Societé Française de Radiologie) scoring system. Association between chest CT severity score and clinical outcome was also assessed. Results: Amongst 197 consecutive cancer patients, 46 were confirmed COVID-19 with available initial chest CT (24 men and 22 women; median age of 67 years). 20/46 had a haematologic disease and 26/46 had a solid malignancy. Sixteen (35%) patients were suspected to have hospital-associated transmission. Common chest CT findings were pure ground-glass opacity (GGO) (39/46, 85%) followed by GGO with consolidation (19/46-41%), pure consolidation (16/46-35%) and crazy paving (16/46-35%). Based on RT-PCR test as standard of reference, chest CT demonstrated 96% sensitivity, 82% specificity, 62%PPV, 98%NPV and 85% accuracy for the diagnosis in the whole population. A total of 19/46 (41%) patients had severe events and the mortality rate was 35% (16/46), 22% (10/46) COVID-related. There was a significant association between the number of lobe involved and the need for hospitalisation, poor progression or death (p=0.04), and between chest CT scoring system and survival (p=.0005). Conclusion: The high performance for diagnosis and severity assessment for COVID-19 suggest to use chest CT to identify infected cancer patients and to early isolate them to avoid nosocomial contamination both for cancer patient and healthcare staff. Ke