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. 2022 Sep 29;12(10):2372.
doi: 10.3390/diagnostics12102372.

The Additional Value of Lower Respiratory Tract Sampling in the Diagnosis of COVID-19: A Real-Life Observational Study

Luca Morandi  1   2 , Francesca Torsani  1 , Giacomo Forini  1 , Mario Tamburrini  1 , Aldo Carnevale  3   4 , Anna Pecorelli  3 , Melchiore Giganti  3   4 , Marco Piattella  1 , Ippolito Guzzinati  1 , Alberto Papi  1   2 , Marco Contoli  1   2
Affiliations

The Additional Value of Lower Respiratory Tract Sampling in the Diagnosis of COVID-19: A Real-Life Observational Study

Luca Morandi et al. Diagnostics (Basel). .

Abstract

Background: Since December 2019, SARS-CoV-2 has been causing cases of severe pneumonia in China and has spread all over the world, putting great pressure on health systems. Nasopharyngeal swab (NPS) sensitivity is suboptimal. When the SARS-CoV-2 infection is suspected despite negative NPSs, other tests may help to rule out the infection. Objectives: To evaluate the yield of the lower respiratory tract (LRT) isolation of SARS-CoV-2. To evaluate the correlations between SARS-CoV-2 detection and clinical symptoms, and laboratory values and RSNA CT review scores in suspect patients after two negative NPSs. To assess the safety of bronchoscopy in this scenario. Method: A retrospective analysis of data from LRT sampling (blind nasotracheal aspiration or bronchial washing) for suspected COVID-19 after two negative NPS. Chest CT scans were reviewed by two radiologists using the RSNA imaging classification. Results: SARS-CoV-2 was detected in 14/99 patients (14.1%). A correlation was found between SARS-CoV2 detection on the LRT and the presence of a cough as well as with typical CT features. Typical CT resulted in 57.1% sensitivity, 80.8% accuracy and 92.3% NPV. Neither severe complications nor infections in the personnel were reported. Conclusions: In suspect cases after two negative swabs, CT scan revision can help to rule out COVID-19. In selected cases, with consistent CT features above all, LRT sampling can be of help in confirming COVID-19.

Keywords: SARS-CoV-2; blind nasotracheal aspiration; bronchoscopy; chest CT; diagnosis.

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Conflict of interest statement

Dr Morandi, L. reports personal fees from Boehringer Ingelheim and Chiesi Farmaceutici outside the submitted work. Dr Contoli reports grants, personal fees and nonfinancial support from Chiesi; personal fees and nonfinancial support from AstraZeneca; personal fees and nonfinancial support from Boehringer Ingelheim; personal fees and nonfinancial support from Alk-Abello; grants, personal fees and nonfinancial support from GlaxoSmithKline; personal fees and nonfinancial support from Novartis; personal fees and nonfinancial support from Zambon; and grants from the University of Ferrara, Italy, outside the submitted work. Dr Papi, A. reports grants, personal fees, nonfinancial support from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici TEVA and Sanofi/Regeneron; personal fees, nonfinancial support from Mundipharma, Zambon and Novartis; grants, personal fees and nonfinancial support from Menarini; personal fees from Roche; grants from Fondazione Maugeri; grants from Fondazione Chiesi; and personal fees from Edmondpharma, outside the submitted work. Drs Torsani, F., Forini, G., Padovani, M., Carnevale, A., Pecorelli, A., Piattella, M. and Guzzinati, I. report no conflict of interest for the present work.

Figures

Figure 1
Figure 1
CT scan, laboratory and clinical scoring system. LDH=lactate dehydrogenase, CRP= C reactive protein, ULN= upper limit of normality, DDU = D-dimer unit, Y = yes, N = no.
See this image and copyright information in PMC

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