Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients with Cancer

Alexander Franklin; Teny M. John; Fareed Khawaja; Ying Jiang; Eduardo Yepez; Jitesh Ahuja; Saadia A. Faiz; Lara Bashoura; Ajay Sheshadri; Vickie R. Shannon; Diwakar D. Balachandran; Kelly McConn; Victor E. Mulanovich; Micah Bhatti; Roy F. Chemaly

doi:10.1093/infdis/jiad272

Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients with Cancer

Alexander Franklin, Teny M. John, Fareed Khawaja, Ying Jiang, Eduardo Yepez, Jitesh Ahuja, Saadia A. Faiz, Lara Bashoura, Ajay Sheshadri, Vickie R. Shannon, Diwakar D. Balachandran, Kelly McConn, Victor E. Mulanovich, Micah Bhatti, Roy F. Chemaly

Research output: Contribution to journal › Article › peer-review

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original language	English (US)
Pages (from-to)	1549-1558
Number of pages	10
Journal	Journal of Infectious Diseases
Volume	228
Issue number	11
DOIs	https://doi.org/10.1093/infdis/jiad272
State	Published - Dec 1 2023

Keywords

COVID-19
PCR
bronchoalveolar lavage
cancer
diagnostics
oncologic

ASJC Scopus subject areas

General Medicine

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10.1093/infdis/jiad272

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Franklin, A., John, T. M., Khawaja, F., Jiang, Y., Yepez, E., Ahuja, J., Faiz, S. A., Bashoura, L., Sheshadri, A., Shannon, V. R., Balachandran, D. D., McConn, K., Mulanovich, V. E., Bhatti, M., & Chemaly, R. F. (2023). Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients with Cancer. Journal of Infectious Diseases, 228(11), 1549-1558. https://doi.org/10.1093/infdis/jiad272

Franklin, A, John, TM , Khawaja, F , Jiang, Y , Yepez, E , Ahuja, J , Faiz, SA , Bashoura, L , Sheshadri, A , Shannon, VR , Balachandran, DD, McConn, K, Mulanovich, VE , Bhatti, M & Chemaly, RF 2023, 'Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients with Cancer', Journal of Infectious Diseases, vol. 228, no. 11, pp. 1549-1558. https://doi.org/10.1093/infdis/jiad272

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title = "Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients with Cancer",

abstract = "Background: 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. Methods: 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. Results: 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. Conclusions: 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.",

keywords = "COVID-19, PCR, bronchoalveolar lavage, cancer, diagnostics, oncologic",

author = "Alexander Franklin and John, {Teny M.} and Fareed Khawaja and Ying Jiang and Eduardo Yepez and Jitesh Ahuja and Faiz, {Saadia A.} and Lara Bashoura and Ajay Sheshadri and Shannon, {Vickie R.} and Balachandran, {Diwakar D.} and Kelly McConn and Mulanovich, {Victor E.} and Micah Bhatti and Chemaly, {Roy F.}",

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doi = "10.1093/infdis/jiad272",

language = "English (US)",

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pages = "1549--1558",

journal = "Journal of Infectious Diseases",

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T1 - Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients with Cancer

AU - Franklin, Alexander

AU - John, Teny M.

AU - Khawaja, Fareed

AU - Jiang, Ying

AU - Yepez, Eduardo

AU - Ahuja, Jitesh

AU - Faiz, Saadia A.

AU - Bashoura, Lara

AU - Sheshadri, Ajay

AU - Shannon, Vickie R.

AU - Balachandran, Diwakar D.

AU - McConn, Kelly

AU - Mulanovich, Victor E.

AU - Bhatti, Micah

AU - Chemaly, Roy F.

PY - 2023/12/1

Y1 - 2023/12/1

N2 - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

AB - Background: 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. Methods: 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. Results: 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. Conclusions: 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.

KW - COVID-19

KW - PCR

KW - bronchoalveolar lavage

KW - cancer

KW - diagnostics

KW - oncologic

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U2 - 10.1093/infdis/jiad272

DO - 10.1093/infdis/jiad272

M3 - Article

C2 - 37983000

AN - SCOPUS:85178495266

SN - 0022-1899

VL - 228

SP - 1549

EP - 1558

JO - Journal of Infectious Diseases

JF - Journal of Infectious Diseases

IS - 11

ER -

Utility of Bronchoalveolar Lavage for the Diagnosis and Management of COVID-19 in Patients with Cancer

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