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. 2020 Aug;9(4):1516-1527.
doi: 10.21037/tlcr-20-892.

COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study

Ya-Jie Zhang  1 , Wen-Jie Yang  2 , Dong Liu  3 , Yu-Qin Cao  1 , Yu-Yan Zheng  1 , Yi-Chao Han  1 , Run-Sen Jin  1 , Yu Han  1 , Xiao-Yang Wang  4 , A-Shan Pan  5 , Jian-Yi Dai  6 , Qing-Feng Sun  6 , Feng-Quan Zhao  7 , Qing-Yuan Yang  3 , Jia-Hao Zhang  1 , Sheng-Jun Liu  8 , Qian Da  9 , Wei Guo  1 , Cheng-Qiang Li  1 , Wen-Tian Zhang  1 , Han Wu  1 , Xing-Shi Chen  1 , An-Qi Ji  1 , Jie Xiang  1 , Kai Chen  1 , Xi-Jia Feng  1 , Xian-Fei Zhang  1 , Qi-Qi Cao  2 , Le Qin  2 , Jian Li  10 , Min Zhou  3 , Yong Lu  2 , Chao-Fu Wang  9 , Fu-Hua Yan  2 , He-Cheng Li  1 , Jie-Ming Qu  3
Affiliations

COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study

Ya-Jie Zhang et al. Transl Lung Cancer Res. 2020 Aug.

Abstract

Background: Radiological manifestations of coronavirus disease 2019 (COVID-19) featured ground-glass opacities (GGOs), especially in the early stage, which might create confusion in differential diagnosis with early lung cancer. We aimed to specify the radiological characteristics of COVID-19 and early lung cancer and to unveil the discrepancy between them.

Methods: One hundred and fifty-seven COVID-19 patients and 374 early lung cancer patients from four hospitals in China were retrospectively enrolled. Epidemiological, clinical, radiological, and pathological characteristics were compared between the two groups using propensity score-matched (PSM) analysis.

Results: COVID-19 patients had more distinct symptoms, tended to be younger (P<0.0001), male (P<0.0001), and had a higher body mass index (P=0.014). After 1:1 PSM, 121 matched pairs were identified. Regarding radiological characteristics, patients with a single lesion accounted for 17% in COVID-19 and 89% in lung cancer (P<0.0001). Most lesions were peripherally found in both groups. Lesions in COVID-19 involved more lobes (median 3.5 vs. 1; P<0.0001) and segments (median 6 vs. 1; P<0.0001) and tended to have multiple types (67%) with patchy form (54%). Early lung cancer was more likely to have a single type (92%) with oval form (66%). Also, COVID-19 and early lung cancer either had some distinctive features on computed tomography (CT) images.

Conclusions: Both COVID-19 and early lung cancers showed GGOs, with similar but independent features. The imaging characteristics should be fully understood and combined with epidemiological history, pathogen detection, laboratory tests, short-term CT reexamination, and pathological results to aid differential diagnosis.

Keywords: Coronavirus disease 2019 (COVID-19); ground glass opacity; lung neoplasms; propensity score; radiology.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/tlcr-20-892). Dr. YJZ reports grants from National Natural Science Foundation of China, during the conduct of the study. Dr. HCL reports grants from National Natural Science Foundation of China, grants from Shanghai Municipal Commission of Health and Family Planning Outstanding Academic Leaders Training Program, grants from Shanghai Municipal Education Commission - Gaofeng Clinical Medicine Grant, during the conduct of the study. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Diagram of patient selection. COVID-19, coronavirus disease 2019.
Figure 2
Figure 2
Involvement of different lobes and segments. COVID-19, coronavirus disease 2019.
Figure 3
Figure 3
CT scans with similar manifestations between COVID-19 and lung cancer. Lesions in (A) and (B) were both presented as GGO: (A) CT scan of a patient diagnosed with COVID-19; (B) CT scan of a patient diagnosed with lung cancer. Lesions in (C) and (D) were both presented as patchy opacification: (C) CT scan of a patient diagnosed with COVID-19; (D) CT scan of a patient diagnosed with lung cancer. COVID-19, coronavirus disease 2019; GGO, ground-glass opacity.
Figure 4
Figure 4
CT scans with distinct manifestations between COVID-19 and lung cancer. Lesions in (A) and (B) were both presented as GGO: (A) CT scan of a patient diagnosed with COVID-19, without pleural retraction or vessel convergence sign; (B) CT scan of a patient diagnosed with lung cancer, with pleural retraction and cystic change. Lesions in (C) and (D) were both presented as patchy opacification: (C) CT scan of a patient diagnosed with COVID-19 presenting irregular shape on CT, without pleural retraction; (D) CT scan of a patient diagnosed with lung cancer, with pleural retraction, lobulated sign, and spiculate protuberance. GGO, ground-glass opacity; COVID-19, coronavirus disease 2019.
Figure 5
Figure 5
Progression of GGOs in COVID-19 and lung cancer. Panels (A) and (B) showed typical evolution on CT scans of a patient diagnosed with COVID-19 who presented with the only cough as a symptom: (A) on day 4; a mixed GGO was demonstrated in the left lower lobe with air bronchogram; (B) on day 11, the primary lesion was significantly enlarged with consolidation. What is more, there was a new area of subpleural patchy opacification in the right lower lobe. Panels (C) and (D) showed the chest CT of a patient diagnosed with lung cancer: (C) a mixed GGO was found in the left upper lobe; (D) no visible change was detected one month later. GGOs, ground-glass opacities; COVID-19, coronavirus disease 2019.
Figure S1
Figure S1
Distribution of propensity score.
Figure S2
Figure S2
Pathological results of COVID-19 (A,B,C,D)1 and early stage lung cancer (E,F,G,H). Scale: 1:200. COVID-19, coronavirus disease 2019. 1, reproduced by permission of the owner of the publishing rights of Reference .
See this image and copyright information in PMC

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