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COVID-19 时代的间质性肺炎:肺癌患者中一个难以鉴别的病症。

Interstitial pneumonitis in the COVID-19 era: a difficult differential diagnosis in patients with lung cancer.

机构信息

Division of Thoracic Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.

出版信息

Tumori. 2021 Jun;107(3):267-269. doi: 10.1177/0300891620951863. Epub 2020 Aug 26.

Abstract

In this coronavirus 2019 (COVID-19) era, when pneumonitis occurs in patients with lung cancer receiving immune checkpoint inhibitors (ICIs), a major challenge is to make a rapid and correct differential diagnosis among drug-induced pulmonary toxicity, tumour progression, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pneumonitis. While waiting for polymerase chain reaction (PCR) testing results, an accurate evaluation of the symptoms and serologic features can help us make a first diagnostic hypothesis and quickly start correct treatment. Physicians need a collaborative effort to develop and share a common database reporting clinical (anosmia, dysgeusia), serologic, and radiologic data in ICI-treated patients with lung cancer developing interstitial disease to create an evidence-based clinical diagnostic algorithm. This tool will continue to be helpful when we emerge from the pandemic crisis into a world in which COVID-19 may not have been eradicated to better select the target population requiring the most resource-consuming PCR tests.

摘要

在这个 2019 年冠状病毒(COVID-19)时代,当接受免疫检查点抑制剂(ICI)治疗的肺癌患者出现间质性肺炎时,主要的挑战是在药物性肺毒性、肿瘤进展和严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)引起的间质性肺炎之间做出快速而正确的鉴别诊断。在等待聚合酶链反应(PCR)检测结果的同时,对症状和血清学特征的准确评估可以帮助我们做出初步诊断假设,并迅速开始正确的治疗。医生需要共同努力,开发并共享一个共同的数据库,报告患有间质性疾病的接受 ICI 治疗的肺癌患者的临床(嗅觉丧失、味觉障碍)、血清学和影像学数据,以创建一个基于证据的临床诊断算法。当我们走出大流行危机进入一个 COVID-19 可能尚未被根除的世界时,这个工具将继续有帮助,以便更好地选择需要进行最耗费资源的 PCR 检测的目标人群。

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