Investigating of the role of CT scan for cancer patients during the first wave of COVID-19 pandemic

Introduction

Amidst this current COVID-19 pandemic, we undertook this systematic review to determine the role of medical imaging, with a special emphasis on computed tomography (CT), on guiding the care and management of oncologic patients.

Material and Methods

Study selection focused on articles from 01/02/2020 to 04/23/2020. After removal of irrelevant articles, all systematic or non-systematic reviews, comments, correspondence, editorials, guidelines and meta-analysis and case reports with less than 5 patients were also excluded. Full-text articles of eligible publications were reviewed to select all imaging-based publications, and the existence or not of an oncologic population was reported for each publication. Two independent reviewers collected the following information: ( 1) General publication data; (2) Study design characteristics; (3) Demographic, clinical and pathological variables with percentage of cancer patients if available; (4) Imaging performances. The sensitivity and specificity of chest CT (C-CT) were pooled separately using a random-effects model. The positive predictive value (PPV) and negative predictive value (NPV) of C-CT as a test was estimated for a wide range of disease prevalence rates.

Results

A total of 106 publications were fully reviewed. Among them, 96 were identified to have extractable data for a two-by-two contingency table for CT performance. At the end, 53 studies (including 6 that used two different populations) were included in diagnosis accuracy analysis (N = 59). We identified 53 studies totaling 11,352 patients for whom the sensitivity (95CI) was 0.886 (0.880; 0.894), while specificity remained low: in 93% of cases (55/59), specificity was ≤ 0.5. Among all the 106 reviewed studies, only 7 studies included oncologic patients and were included in the final analysis for C-CT performances. The percentage of patients with cancer in these studies was 0.3% (34/11352 patients), lower than the global prevalence of cancer. Among all these studies, only 1 (0.9%, 1/106) reported performance specifically in a cohort of cancer patients, but it however only reported true positives.

Discussion

There is a concerning lack of COVID-19 studies involving oncologic patients, showing there is a real need for further investigation and evaluation of the performance of the different medical imaging modalities in this specific patient population.