AUTHOR=Tang Wei , Wang Fei , Wang Jian-Wei , Huang Yao , Liu Li , Zhao Shi-Jun , Zhao Xin-Ming , Wu Ning 

TITLE=Developing a Screening Procedure During the COVID-19 Pandemic: Process and Challenges Faced by a Low-Incidence Area

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.654754

DOI=10.3389/fmed.2021.654754

ISSN=2296-858X

ABSTRACT=Purpose: To summarize the imaging results of COVID-19 pneumonia and develop a CT screening procedure for patients at our institution with malignant tumors. 
Methods: Following epidemiological investigation, 1,429 patients preparing to undergo anti-tumor-treatment underwent CT scans between February 17th and April 16th, 2020. Where CT findings showed suspected COVID-19 pneumonia after the supervisor radiologist and the thoracic experience radiologist had double-read the initial CT images, radiologists would report the result to our hospital infection control staff. Necessary further examinations, including the RT-PCR test, in the assigned hospital was strongly recommended for patients with positive CT results. The CT examination room would perform sterilization for 30 minutes to 1 hour. If the negative results of any suspected COVID-19 pneumonia CT findings were identified, the radiologists would upload the results to our Hospital Information Systems and inform clinicians within two hours.
Results: Fifty (0.35%, 50/1,429) suspected pneumonia cases including 29 males and 21 females (median age: 59.5 years old; age range 27-79 years) were identified. 34.0% (17/50) patients had a history of lung cancer and 54.0 (27/50) underwent chemotherapy or targeted therapy. 46 patients (92.0%) had prior CT scans, and 35 patients (76.1%) with suspected pneumonia were newly seen (median interval time: 62 days). Sub-pleura small patchy or strip-like lesions most likely due to fibrosis or hypostatic pneumonia and cluster of nodular lesions were the two main signs of suspected cases on CT images (34, 68.0%). 27 patients (54.0%) had at least once follow up CT scan (median interval time: 18.0 days). Only one patient had an increase in size (interval time: 8 days), the immediately RT-PCR test result was negative.
Conclusion: CT may be useful as a screening tool for COVID-19 based on imaging features. But The differential diagnosis between COVID-19 and other pulmonary infection and/or non-infectious disease is very difficult due to its overlapping imaging features. The confirmed diagnosis of the COVID-19 infection should be based on the etiologic eventually. The cancer patients at a low-incidence area would continue treatment by screening carefully before admission.