Department of Infectious Diseases, Infection Control and Employee Heath, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
J Infect Dis. 2023 Nov 28;228(11):1549-1558. doi: 10.1093/infdis/jiad272.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) on nasopharyngeal swab (NPS), remains the most reliable and practical test to diagnose coronavirus disease 2019 (COVID-19). Current literature is sparse regarding the rates of discordance between NPS and bronchoalveolar lavage (BAL) in patients with cancer.
We conducted a retrospective cohort study of adult patients with cancer who had BAL samples tested for SARS-CoV-2 at a comprehensive cancer center. Patients without NPS PCR for SARS-CoV-2 before BAL were excluded.
In a cohort of 345 patients, 12% and 17% tested positive for SARS-CoV-2 on NPS and BAL, respectively. There was a 6.3% NPS-/BAL+ discordance rate and a 9.5% NPS+/BAL- discordance rate. Patients with lymphoma (adjusted odds ratio [aOR] = 4.06; P = .007) and Hispanic patients (aOR = 3.76; P = .009) were more likely to have NPS-/BAL+ discordance on multivariate analysis. Among patients with NPS- /BAL- for SARS-CoV-2, an alternate infectious (23%) and a noninfectious etiology (16%) were identified in BAL.
Our discordance rates between NPS and BAL were sufficient to recommend BAL in certain patients with cancer with a high clinical suspicion of COVID-19. BAL has value in identifying alternative etiologies of illness in patients with suspected or confirmed COVID-19.
针对新型冠状病毒（SARS-CoV-2）的聚合酶链反应（PCR）检测鼻咽拭子（NPS）仍是诊断 2019 冠状病毒病（COVID-19）最可靠和实用的方法。目前有关癌症患者中 NPS 与支气管肺泡灌洗（BAL）之间不一致率的文献很少。
我们对在综合癌症中心进行 BAL 样本 SARS-CoV-2 检测的成年癌症患者进行了回顾性队列研究。排除了 BAL 之前未进行 NPS PCR SARS-CoV-2 检测的患者。
在 345 例患者中，分别有 12%和 17%的患者 NPS 和 BAL 对 SARS-CoV-2 检测呈阳性。NPS-/BAL+的不一致率为 6.3%，NPS+/BAL-的不一致率为 9.5%。在多变量分析中，淋巴瘤患者（调整后的优势比[aOR] = 4.06；P =.007）和西班牙裔患者（aOR = 3.76；P =.009）更有可能出现 NPS-/BAL+不一致。在 SARS-CoV-2 检测呈 NPS-/BAL-的患者中，BAL 中确定了其他感染（23%）和非感染性病因（16%）。
我们的 NPS 和 BAL 之间的不一致率足以推荐某些 COVID-19 临床高度怀疑的癌症患者进行 BAL。BAL 可用于确定疑似或确诊 COVID-19 患者的其他疾病病因。
