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Increased incidence of interstitial pneumonia detected on [18F]-FDG-PET/CT in asymptomatic cancer patients during COVID-19 pandemic in Lombardy: a casualty or COVID-19 infection?

Authors
  • Setti, Lucia1
  • Bonacina, Manuela1
  • Meroni, Roberta2
  • Kirienko, Margarita3
  • Galli, Francesca4
  • Dalto, Serena Camilla5
  • Erba, Paola Anna6
  • Bombardieri, Emilio7
  • 1 Nuclear Medicine Unit, Humanitas Gavazzeni, Bergamo, Italy. , (Italy)
  • 2 Radiology Unit, Humanitas Gavazzeni, Bergamo, Italy. , (Italy)
  • 3 Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy. [email protected] , (Italy)
  • 4 Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy. , (Italy)
  • 5 Clinical Oncology Unit, Humanitas Gavazzeni, Bergamo, Italy. , (Italy)
  • 6 Department of Nuclear Medicine, Department of Translational Research and New Technology in Medicine, University of Pisa, Pisa, Italy. , (Italy)
  • 7 Scientific Direction and Nuclear Medicine Unit, Humanitas Gavazzeni, Bergamo, Italy. , (Italy)
Type
Published Article
Journal
European Journal of Nuclear Medicine
Publisher
Springer-Verlag
Publication Date
Mar 01, 2021
Volume
48
Issue
3
Pages
777–785
Identifiers
DOI: 10.1007/s00259-020-05027-y
PMID: 32909090
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The study aimed to compare the incidence of interstitial pneumonia on [18F]-FDG PET/CT scans between two 6-month periods: (a) the COVID-19 pandemic peak and (b) control period. Secondly, we compared the incidence of interstitial pneumonia on [18F]-FDG PET/CT and epidemiological data from the regional registry of COVID-19 cases. Additionally, imaging findings and the intensity of [18F]-FDG PET/CT uptake in terms of maximum standardized uptake value (SUVmax) were compared. We retrospectively analyzed [18F]-FDG PET/CT scans performed in cancer patients referred to nuclear medicine of Humanitas Gavazzeni in Bergamo from December 2019 to May 2020 and from December 2018 to May 2019. The per month incidence of interstitial pneumonia at imaging and the epidemiological data were assessed. To evaluate the differences between the two symmetric groups (period of COVID-19 pandemic and control), the stratified Cochran-Mantel-Haenszel test was used. Chi-square test or Fisher's exact test and t test or Wilcoxon test were performed to compare the distributions of categorical and continuous variables, respectively. Overall, 1298 patients were included in the study. The two cohorts-COVID-19 pandemic (n = 575) and control (n = 723)-did not statistically differ in terms of age, disease, or scan indication (p > 0.05). Signs of interstitial pneumonia were observed in 24 (4.2%) and 14 patients (1.9%) in the COVID-19 period and the control period, respectively, with a statistically significant difference (p = 0.013). The level of statistical significance improved further when the period from January to May was considered, with a peak in March (7/83 patients, 8.4% vs 3/134 patients, 2.2%, p = 0.001). The curve of interstitial pneumonia diagnosis overlapped with the COVID-19 incidence in the area of Lombardy (Spearman correlation index was equal to 1). Imaging data did not differ among the two cohorts. Significant increase of interstitial lung alterations at [18F]-FDG PET/CT has been demonstrated during the COVID-19 pandemic. Additionally, the incidence curve of imaging abnormalities resulted in resembling the epidemiological data of the general population. These data support the rationale to adopt [18F]-FDG PET/CT as sentinel modality to identify suspicious COVID-19 cases to be referred for additional confirmatory testing. Nuclear medicine physicians and staff should continue active surveillance of interstitial pneumonia findings, especially when new infection peak is expected.

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