BACKGROUND:Interstitial lung disease (ILD)/pneumonitis is an important adverse drug reaction associated with trastuzumab deruxtecan (T-DXd). This report comprehensively characterized clinical and imaging features of T-DXd-related ILD, systematically evaluated by an independent ILD Adjudication Committee (AC), in Japanese patients with breast/gastric cancer from all-patient post-marketing surveillance studies. PATIENTS AND METHODS:This post hoc analysis evaluated independent ILD AC-adjudicated T-DXd-related ILD cases. Demographics, clinical/radiological features, time to onset, treatment interventions, and outcomes (followed up to 12 months from onset) were analyzed. RESULTS:Among 2801 T-DXd-treated patients (breast cancer: 1731; gastric cancer: 1070), 421 potential cases were reviewed: 381 were adjudicated as T-DXd-related ILD (breast cancer: 278; gastric cancer: 103). Median age was 65.0 years, 75.1% were female, and 28.3% had a smoking history. ILD occurred throughout observation (including fatal cases ≥12 months post-initiation) with no specific onset window. Time to onset did not differ across CTCAE grades. Organizing pneumonia was the predominant imaging pattern (67.7%), followed by hypersensitivity pneumonitis (14.2%) and diffuse alveolar damage (DAD, 12.6%). Most cases (78.2%) were worst CTCAE Grade 1-2. Grade 5 ILD occurred in 30 patients (7.9%), with DAD the most common pattern (26 patients). Overall recovery was 83.5%. Corticosteroids were used in 54.6% of cases, with 79.3% responding. High-dose corticosteroids and additional immunosuppressants were ineffective in seven DAD cases. CONCLUSIONS:Most T-DXd-related ILD cases were mild/moderate and corticosteroid-responsive; DAD pattern was associated with higher mortality. These findings underscore the importance of vigilant monitoring, early recognition, and prompt corticosteroid treatment to mitigate fatal T-DXd-related ILD.

Background:In early-stage non-small cell lung cancer (NSCLC), the presence of a ground-glass opacity (GGO) component in the primary lesion on high-resolution computed tomography (CT) is recognized as a favorable prognostic factor. Even in NSCLC with a GGO component, lymph node metastases are occasionally detected during or after surgery. However, the prognostic impact of GGO components in these patients has not been clarified. We aimed to examine the prognostic significance of GGO components as radiological findings of primary lesions of completely resected NSCLC with pathological nodal involvement.Methods:This study included 290 patients (11%) with pathological nodal involvement among 2,546 patients who underwent complete resection of NSCLC at our institution. Patients with an unknown primary lesion (T0) or centrally located lung cancer were excluded. The 290 patients were divided into two groups [i.e., the part-solid ("PS") and "Solid" groups] according to the radiological findings of the primary lesion, and their clinicopathological characteristics and prognoses were compared. Furthermore, a multivariate analysis was performed using the Cox proportional hazards model to examine the factors affecting the overall survival (OS).Results:The OS in the PS group (n=58) was significantly longer than that in the Solid group (n=232; P=0.039). However, multivariate analysis only revealed age [hazard ratio (HR) =1.77; 95% confidence interval (CI): 1.15-2.72] and the clinical T factor (HR =1.58; 95% CI: 1.01-2.47), but not the radiological findings of primary lesions, as the independent prognostic factors. Furthermore, the OS did not differ significantly between the PS and Solid groups matched for the clinical T and N factors (n=58 patients each).Conclusions:GGO components in the primary lesion, considered a decisive prognostic factor in early-stage NSCLC, did not affect the prognosis of patients with NSCLC and pathological nodal involvement.

Central picture (78/90)A cystic lesion appeared when the muscular layer of the diaphragm was divided. Central message (193/200)Intradiaphragmatic bronchogenic cyst is a rare benign disease that is difficult to diagnose owing to its location.Accurate preoperative diagnosis by MRI and minimally invasive surgery are ideal.

Background Interstitial lung disease/pneumonitis (ILD/pneumonitis) has been identified as a drug-related adverse event of special interest of trastuzumab deruxtecan (T-DXd), but there were a few reports of T-DXd-related ILD/pneumonitis in clinical practice. Methods Between May 25, 2020 (the launch of T-DXd in Japan) and February 24, 2022, there were 287 physician-reported potential ILD/pneumonitis cases from the Japanese post-marketing all-case surveillance. By February 27, 2022, an independent adjudication committee assessed 138 cases and adjudicated 130 cases as T-DXd-related ILD/pneumonitis. The clinical features and imaging characteristics of these cases were evaluated. Results The majority of adjudicated T-DXd-related ILD/pneumonitis cases were grade 1 or 2 (100/130, 76.9%). The most common radiological pattern types observed were organizing pneumonia patterns (63.1%), hypersensitivity pneumonitis patterns (16.9%), and diffuse alveolar damage (DAD) patterns (14.6%). Eleven cases (8.5%) from 130 resulted in death; the majority of these (8/11, 72.7%) had DAD patterns. The overall proportion of recovery (including the outcomes of recovered, recovered with sequelae, and recovering) was 76.9%, and the median time to recovery was 83.5 days (interquartile range: 42.25–143.75 days). Most cases (59/71, 83.1%) that were treated with corticosteroids were considered responsive to treatment. Conclusions This is the first report to evaluate T-DXd-related ILD/pneumonitis cases in clinical practice. Our findings are consistent with previous reports and suggest that patients with DAD patterns have poor outcomes. Evaluation of a larger real-world dataset may further identify predictors of clinical outcome.

Durvalumab is the global standard-of-care for the consolidation treatment of locally-advanced, unresectable NSCLC following definitive chemoradiotherapy based on the results of the PACIFIC trial. Since interstitial lung disease/radiation pneumonitis (ILD/RP) was more frequently observed in Japanese patients (73.6%) than seen globally (33.9%) in the PACIFIC trial, safety including ILD/RP risk was assessed in a post-marketing study.

BACKGROUND. Differentiation of primary lung cancers and pulmonary metastases may present a diagnostic dilemma given overlapping CT findings. OBJECTIVE. The purpose of this study was to compare the utility of ringlike peripheral increased iodine concentration and conventional findings for differentiating primary lung cancers from pulmonary metastases on dual-energy CT (DECT). METHODS. This retrospective study included 93 patients (64 men, 29 women; median age, 70 years) who underwent resection of a primary lung cancer (n = 68) or pulmonary metastasis (n = 25) corresponding to a solid lesion on preoperative contrast-enhanced DECT performed between April 2020 and March 2021. Venous phase 120-keV single-energy images, equilibrium phase 66-keV virtual monoenergetic images, and iodine concentration maps were reconstructed. Two radiologists independently assessed lesions for spiculated margins, air bronchograms, rim enhancement, and thin ringlike peripheral high iodine concentration; differences were resolved by consensus. Inter-reader agreement and diagnostic performance were assessed. Multivariable logistic regression analysis incorporated additional patient and lesion characteristics. RESULTS. Interobserver agreement, expressed as kappa, was 0.26 for spiculated margins, 0.60 for air bronchograms, 0.56 for rim enhancement, and 0.80 for ringlike peripheral high iodine concentration. Pulmonary metastases, compared with primary lung cancers, exhibited significantly higher frequency of ringlike peripheral high iodine concentration (52% vs 19%; p = .004) but no significant difference in frequency of spiculated margins (49% vs 32%; p = .17), air bronchograms (36% vs 51%; p = .24), or rim enhancement (4% vs 4%; p > .99). Sensitivity and specificity for diagnosing pulmonary metastasis were 68% and 49% for absence of spiculated margins, 64% and 51% for absence of air bronchograms, 4% and 96% for presence of rim enhancement, and 52% and 81% for presence of ringlike peripheral high iodine concentration. In multivariable analysis including smoking history, lesion diameter, multiple resected lesions, and ringlike peripheral high iodine concentration, the only independent significant predictor of pulmonary metastasis was ringlike peripheral high iodine concentration (OR, 7.81 [95% CI, 2.28-29.60); p = .001). CONCLUSION. Ringlike peripheral high iodine concentration had excellent interobserver agreement and high specificity (albeit poor sensitivity) for differentiating pulmonary metastasis from primary lung cancer and was independently predictive of pulmonary metastasis. CLINICAL IMPACT. Ringlike peripheral high iodine concentration could help guide management of patients with known cancer and an indeterminate solitary nodule.

Purpose: The purpose of this study was to investigate whether ex-vivo MRI enables accurate estimation of the invasive component of lung adenocarcinoma. Methods: We retrospectively reviewed 32 patients with lung adenocarcinoma who underwent lung lobectomy. The specimens underwent MRI at 1.5T. The boundary between the lesion and the normal lung was evaluated on a 5-point scale in each three MRI sequences, and a one-way analysis of variance and post-hoc tests were performed. The invasive component size was measured histopathologically. The maximum diameter of each solid component measured on CT and MR T1-weighted (T1W) images and the maximum size obtained from histopathologic images were compared using the Wilcoxon signed-rank test. Inter-reader agreement was evaluated using intraclass correlation coefficients (ICC). Results: T1W images were determined to be optimal for the delineation of the lesions (P < 0.001). The histopathologic invasive area corresponded to the area where the T1W ex-vivo MR image showed a high signal intensity that was almost equal to the intravascular blood signal. The maximum diameter of the solid component on CT was overestimated compared with the maximum invasive size on histopathology (mean, 153%; P < 0.05), while that on MRI was evaluated mostly accurately without overestimation (mean, 108%; P = 0.48). The interobserver reliability of the measurements using CT and MRI was good (ICC = 0.71 on CT, 0.74 on MRI). Conclusion: Ex-vivo MRI was more accurate than conventional CT in delineating the invasive component of lung adenocarcinoma.

We investigated the prognostic significance of PET findings based on the radiological appearance of stage IA lung adenocarcinoma. More aggressive clinicopathological features and significantly worse outcomes were features of PET-positive par t-solid nodules (PSNs) in comparison to PET-negative PSNs, but not in solid nodules. Thus, the prognostic impact of PET findings differs between par t-solid and solid nodules. Introduction: Although solid appearance on computed tomography and positive findings on positron emission tomog-raphy (PET) have been both associated with poor outcome in lung adenocarcinoma, the extent to which these findings overlap is unknown. This study aimed to determine the differences in prognostic significance of PET findings in part-solid nodules (PSNs) and solid nodules. Materials and Methods: We retrospectively investigated 417 patients with clinical stage IA adenocarcinoma who underwent curative resection between 2010 and 2017. We compared disease-free survival (DFS), cumulative incidence of disease recurrence (CIR) and clinicopathological characters between PET-positive and negative groups among PSNs and solid nodules, respectively. We used 2.5 as a cut-off value of maximum standardized uptake value (SUV max). Results: In PSNs (n = 235), PET-positive group (n = 59) showed more aggres-sive features in several clinicopathological variables, poorer DFS ( P < .001) and higher CIR ( P < .001) than PET-negative group (n = 176). In contrast, in solid nodules (n = 182), DFS ( P = .521) and CIR ( P = .311) were not significantly different between PET-positive (n = 128) and negative groups (n = 54). SUV max was proved to be the independent prognos-tic factor of DFS by multivariate analysis (HR, 1.155; 95% CI, 1.036-1.287) only in PSNs. Conclusion: These findings showed distinct impact on prognosis of PET findings between PSNs and solid nodules. PET-positive finding was more important prognostic factor in PSNs than in solid nodules among clinical stage IA lung adenocarcinoma.

IntroductionAlthough several studies have investigated the prognostic significance of the radiographic appearance of stage IA lung adenocarcinoma, the prognostic impact of solid component size or consolidation-to-tumor ratio (CTR) of part-solid nodules (PSNs) still remains controversial. This study aimed to clarify the combined prognostic impact of the mentioned radiographic features of PSNs and compare it with that of pure solid nodules in the current TNM classification.MethodsWe retrospectively investigated 1014 patients with clinical stage IA (TNM eighth edition) adenocarcinoma who underwent curative resection. Overall survival (OS) and pathologic characteristics of pure solid nodules, solid-dominant PSNs (CTR > 0.5), and ground-glass opacity (GGO)-dominant PSNs (CTR ≤ 0.5) were compared according to T category.ResultsPatients with pure solid nodules (297 cases) had significantly shorter OS compared with those with PSNs (717 cases) (p < 0.001) but a marginal difference compared with those with solid-dominant PSNs (286 cases) (p = 0.051). No significant difference in OS was found according to T category in those with GGO-dominant PSNs (431 cases). Patients with cT1b and T1c solid-dominant PSNs had significantly worse prognosis compared with those with other PSNs and had comparable prognosis with those with cT1b pure solid nodules (p = 0.892). Higher frequency of nodal and lymphovascular involvement and pathologic upstaging was observed with T category progression in solid-dominant PSNs.ConclusionsAn hierarchy of prognosis and pathologic malignant characteristics was observed according to T category in patients with solid-dominant PSNs but not in those with GGO-dominant PSNs, suggesting the importance of classifying PSNs on the basis of solid component size and CTR for accurate prognostic comparison with pure solid nodules.

日本肺癌学会肺がん検診委員会は，2022年に「肺がん検診ガイドライン」の改訂を行った．本稿では改訂に至った経過とその概要について解説する．「現行検診」に対する「推奨」は2010年ガイドラインから変化はなかった．全国的な精度管理の徹底や，国全体の死亡率減少効果への寄与度や感度・特異度の測定などに関する評価が必要である．「重喫煙者に対する低線量CT検診」は，欧米において肺癌死亡率減少効果のエビデンスが得られたが，過剰診断，偽陽性，放射線被ばくなどの不利益は無視できない．安易な導入を行って混乱する事態を避けるためには，まずは適切な「実装研究」を行うことにより，日本の社会にどのように導入することが望ましいのかを検討することが重要である．一方，「非/軽喫煙者に対する低線量CT検診」は，現在のところ有効性のエビデンスは十分でないため，それを集積することが第一に重要である．

Nivolumab, a human monoclonal antibody against programmed death-1, is approved for the treatment of non-small cell lung cancer (NSCLC). Although nivolumab is generally well tolerated, it can cause interstitial lung disease (ILD), a rare but potentially fatal immune-related adverse event. Currently, there are limited data available on the treatment of nivolumab-induced ILD and its outcome. This retrospective cohort study based on a post-marketing study described the treatment of nivolumab-induced ILD and its outcome in NSCLC patients in Japan through the assessment of clinical and chest imaging findings by an expert central review committee. Treatment details for patients who experienced a relapse of ILD were also analyzed. Of the 238 patients identified as having nivolumab-induced ILD, 37 patients died of ILD. Corticosteroids were used in 207 (87.0%) patients. Of those, 172 (83.1%) patients responded well and survived and 35 (16.9%) died (most died during corticosteroid treatment). A total of nine patients experienced a relapse; at the time of relapse, four patients were taking nivolumab. Of those who were receiving corticosteroids at the time of relapse, three of four patients were taking low doses or had nearly completed dose tapering. All patients (except one, whose treatment was unknown) received corticosteroids for the treatment of relapse, but one patient died. Patients with NSCLC who experience nivolumab-induced ILD are treated effectively with corticosteroids, and providing extra care when ceasing or reducing the corticosteroid dose may prevent relapse of ILD.

Nivolumab can cause interstitial lung disease (ILD), which may be fatal; however, mortality risk factors have not been identified. This postmarketing study evaluated the poor prognostic factors of ILD in nivolumab-treated patients with non–small cell lung cancer (NSCLC) in Japan. Clinical and chest imaging findings for each ILD case were assessed by an expert central review committee, and prognosis was evaluated by radiographic findings, including the presence/absence of peritumoral ground-glass opacity (peritumoral-GGO). Poor prognostic factors were identified by univariate and multivariate Cox regression analysis. Of the 238 patients with nivolumab-induced ILD, 37 died. The main radiographic patterns of ILD were cryptogenic organizing pneumonia/chronic eosinophilic pneumonia–like (53.4%), faint infiltration pattern/acute hypersensitivity pneumonia–like (20.2%), diffuse alveolar damage (DAD)-like (10.9%), and nonspecific interstitial pneumonia–like (6.3%). The main poor prognostic factors identified were DAD-like pattern (highest hazard ratio: 10.72), ≤60 days from the start of nivolumab treatment to the onset of ILD, pleural effusion before treatment, lesion distribution contralateral or bilateral to the tumor, and abnormal change in C-reactive protein (CRP) levels. Of the 37 deaths due to ILD, 17 had DAD-like radiographic pattern, three had peritumoral-GGO, and five had a change in radiographic pattern from non-DAD at the onset to DAD-like. Patients with NSCLC who develop ILD during nivolumab treatment should be managed carefully if they have poor prognostic factors such as DAD-like radiographic pattern, onset of ILD ≤60 days from nivolumab initiation, pleural effusion before nivolumab treatment, lesion distribution contralateral or bilateral to the tumor, and abnormal changes in CRP levels.

━━ Based on a questionnaire survey, the Lung Cancer Screening Committee considers that the aging of doctors involved in lung cancer screening and the high coverage rate of non-specialist doctors are problems; thus, the acquisition of new reading doctors and maintaining and improving the reading ability for doctors who currently perform reading, are considered very important. In 2012, we published Chest X-ray Interpretation Text-book for Lung Cancer Screening with the aim of solving these problems; however, we needed a method to apply the knowledge learned there. In 2018, screening image data were collected from facilities related to the Lung Cancer Screening Committee members, and the image data were evaluated by central judgment. Based on the data and results, we have developed a system that enables interpretation exercises similar to the examination interpretation environment. In May 2019, it started operation as a system that members can practice anytime and any-where via the internet. It is now stably operated at more than one year after the start of operation. This paper ex-plains the progress of the development of this system and how it is used. It also reports the usage status. ( JJLC. 2021;61:69-76)

•Coexistence of interstitial lung disease (ILD) and lung cancer has a poor prognosis.•Tumor doubling time (TDT) of lung cancer is related to long-term outcomes.•We aimed to identify the relationship between the TDT of lung cancer and underlying ILD.•The TDT was significantly shorter in patients with ILD.•The presence of the UIP pattern was not related to the TDT among patients with ILD.

Abstract Background: Amidst the coronavirus disease (COVID-19) pandemic, pre-admission chest computed tomography (CT) screening has been performed for all patients (pts) scheduled for cancer surgery to prevent the nosocomial spread of COVID-19 at our cancer center in Tokyo. This strategy was employed owing to a shortage of polymerase chain reaction assay opportunities and the relatively abundant availability of CT scanning in Japan. Notably, a screening CT may reveal incidental findings that are different from the original purpose of the examination. Thus far, there are no reports of incidental malignant findings on CT scans for COVID-19 screening. Methods: This single-institutional retrospective study included pts scheduled for surgery and who underwent pre-admission CT scans for COVID-19 screening between April 26, 2020, and June 12, 2020. Clinical and radiological data of pts were extracted from medical records. Clinical data included age, sex, medical history, and treatment. All CT scans for COVID-19 screening were examined one or two days before surgery and interpreted by two trained radiologists. This study aimed to reveal the ratio of incidental findings related to malignancy. Results: Between April 26, 2020, and June 12, 2020, 863 pts underwent pre-admission CT scans for COVID-19 screening. Median patient age was 58 years (range, 11-91 years), and 511 (59%) of the pts were female. The most common disease was breast cancer (n = 165, 19%), followed by colorectal cancer (n = 108, 13%), gynecological cancer (n = 107, 12%), and other cancers (n = 483, 56%). CT scan revealed radiological findings of pneumonia in 23 pts (2.7%); therefore, surgery was postponed for these pts. Incidental findings were detected in 28 pts (3.2%), including one pneumothorax and 27 findings related to malignancies. The present study included 165 pts (19%) with breast cancer and who were scheduled for curative surgery. Among them, incidental findings related to malignancies were detected in nine pts (5.5%), including small ground-glass pulmonary nodules (GGN) (n=5), pancreatic duct dilatation (n=1), suspected vertebral metastasis (n=2) and suspected liver tumor (n=1). All pts did not undergo breast surgery but underwent additional examinations after surgery. Five pts (2.5%) with GGN needed follow-up. One patient’s pancreatic duct dilatation was diagnosed as benign using ultrasound. One patient with suspected vertebral metastasis was diagnosed with degenerative changes. The other patient was diagnosed with multiple bone metastases by bone scintigraphy, and further treatment was planned. Pre-admission screening CT scan for pts with other cancers was performed in 698 pts (81%). Among them, findings related to malignancies were detected in 18 pts (2.6%), including breast nodules (n=3), lung nodules (n=5), liver metastasis (n=1), progression of metastasis (n=3), mediastinum tumor (n=1), and GGN (n=5). Two of the three pts with breast nodules were diagnosed with invasive breast cancer and planned for breast surgery after the current cancer treatment. Two pts developed new lung metastasis, and the surgical strategy was changed. The progression of known liver or lung metastasis was detected in three pts, which led to the addition of systemic chemotherapy without modification of surgical treatment. One patient had a mediastinum tumor, and an MRI evaluation after surgery revealed an athymic cyst. Five pts were determined to have GGN, and follow-up was required. Conclusion: The proportion of pts for whom pre-admission CT for COVID-19 revealed incidental findings was 3.2%. Incidental breast cancer was found in 0.4% of female pts. GGNs needed follow-up examination in 2.5% of operable breast cancer pts. Physicians and surgeons should be aware of incidental malignant findings in the COVID-19 screening CT scan. Citation Format: Jun Masuda, Akemi Kataoka, Katsunori Oikado, Natsue Uehiro, Yukinori Ozaki, Lina Inagaki, Chieko Kato, Hidemoto Morizono, Toshimi Takano, Takayuki Ueno, Shinji Ohno. Incidental malignant findings on pre-admission chest computed tomography scan for coronavirus disease screening in patients with breast cancer or other cancers [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS2-32.

Nivolumab can cause interstitial lung disease (ILD), which may be fatal; however, mortality risk factors have not been identified. This postmarketing study evaluated the poor prognostic factors of ILD in nivolumab‐treated patients with non–small cell lung cancer (NSCLC) in Japan. Clinical and chest imaging findings for each ILD case were assessed by an expert central review committee, and prognosis was evaluated by radiographic findings, including the presence/absence of peritumoral ground‐glass opacity (peritumoral‐GGO). Poor prognostic factors were identified by univariate and multivariate Cox regression analysis. Of the 238 patients with nivolumab‐induced ILD, 37 died. The main radiographic patterns of ILD were cryptogenic organizing pneumonia/chronic eosinophilic pneumonia–like (53.4%), faint infiltration pattern/acute hypersensitivity pneumonia–like (20.2%), diffuse alveolar damage (DAD)‐like (10.9%), and nonspecific interstitial pneumonia–like (6.3%). The main poor prognostic factors identified were DAD‐like pattern (highest hazard ratio: 10.72), ≤60 days from the start of nivolumab treatment to the onset of ILD, pleural effusion before treatment, lesion distribution contralateral or bilateral to the tumor, and abnormal change in C‐reactive protein (CRP) levels. Of the 37 deaths due to ILD, 17 had DAD‐like radiographic pattern, three had peritumoral‐GGO, and five had a change in radiographic pattern from non‐DAD at the onset to DAD‐like. Patients with NSCLC who develop ILD during nivolumab treatment should be managed carefully if they have poor prognostic factors such as DAD‐like radiographic pattern, onset of ILD ≤60 days from nivolumab initiation, pleural effusion before nivolumab treatment, lesion distribution contralateral or bilateral to the tumor, and abnormal changes in CRP levels.

Kadoya, Yoshisuke MD; Oikado, Katsunori MD; Ishiyama, Mitsutomi MD; Tanaka, Hiroko MD; Matsueda, Kiyoshi MD; Ninomiya, Hironori MD, PhD; Nakao, Masayuki MD; Okumura, Sakae MD; Mun, Mingyon MD, PhD Author Information

As the coronavirus disease 2019 (COVID-19) pandemic continues, cancer patients were found to be vulnerable and to have difficulty receiving routine care. We analyzed patients who received screening for COVID-19 at The Cancer Institute Hospital of Japanese Foundation for Cancer Research from April 13, 2020, to June 19, 2020. A total of 58,584 cases were screened by a questionnaire, and 231 patients underwent chest computed tomography (CT), among which 12 patients had typical CT findings indicative of COVID-19 and 107 patients received the polymerase chain reaction (PCR) test for SARS-COV-2 with 0% infection prevalence (Table S1). Our study concludes that the incidence of COVID-19 in cancer patients is low in Japan, even among those with COVID-19-like symptoms and typical CT findings, and that proper management is required for preventing virus transmission and maintaining treatment for cancer patients during the pandemic. The ongoing worldwide COVID-19 pandemic dramatically affects daily care for patients with cancer. Patients of COVID-19 with cancer were found to have a high mortality rate, and preventing the transmission of SARS-CoV-2 in a cancer hospital is important for maintaining cancer treatment (Lee et al., 2020aLee L.Y. Cazier J.B. Angelis V. Arnold R. Bisht V. Campton N.A. Chackathayil J. Cheng V.W. Curley H.M. Fittall M.W. et al.UK Coronavirus Monitoring Project TeamCOVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study.Lancet. 2020; 395: 1919-1926Abstract Full Text Full Text PDF PubMed Scopus (845) Google Scholar). However, cancer patients frequently exhibit cancer-specific or treatment-specific symptoms that resemble those of COVID-19 (Al-Shamsi et al., 2020aAl-Shamsi H.O. Alhazzani W. Alhuraiji A. Coomes E.A. Chemaly R.F. Almuhanna M. Wolff R.A. Ibrahim N.K. Chua M.L.K. Hotte S.J. et al.A practical approach to the management of cancer patients during the novel coronavirus disease 2019 (COVID-19) pandemic: an international collaborative group.Oncologist. 2020; 25: e936-e945Crossref PubMed Scopus (471) Google Scholar; Naidoo et al., 2020Naidoo J. Reuss J.E. Suresh K. Feller-Kopman D. Forde P.M. Mehta Steinke S. Rock C. Johnson D.B. Nishino M. Brahmer J.R. Immune-related (IR)-pneumonitis during the COVID-19 pandemic: multidisciplinary recommendations for diagnosis and management.J. Immunother. Cancer. 2020; 8: e000984Crossref PubMed Scopus (14) Google Scholar). Thus, it is essential to establish a screening strategy for patients with COVID-19-like symptoms to prevent further infections and to provide cancer care. As of April 13, 2020, there were 7,255 cases of COVID-19 in Japan, ranked 5th in Asia and 24th in the world in terms of total COVID-19 cases, and experiencing the apex of the pandemic (World Health Organization, 2020World Health OrganizationCoronavirus disease 2019 (COVID-19) Situation Report – 84.https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200413-sitrep-84-covid-19.pdf?sfvrsn=44f511ab_2Date: 2020Google Scholar). In response to these difficulties, we screened 58,584 patients who visited our hospital from April 13, 2020, to June 19, 2020, by using a two-step screening strategy combining a questionnaire, a chest CT, and a nasopharyngeal PCR swab. The questionnaire asked about (1) the patient's contact with COVID-19 patients within the past 2 weeks, (2) the patient's history of travelling abroad within the past 2 weeks, (3) fever over 37.5°C within 3 days, (4) cough and/or shortness of breath appearing within the past 2 weeks, and (5) dysgeusia and/or dysosmia appearing within the past 2 weeks. If patients met one of these criteria, they underwent second screening including chest CT and the PCR test for SARS-CoV-2 if necessary. After answering the questionnaire, 231 patients underwent a second screening (Table S1). The median patient age was 67 years (IQR, 55–72), and 116 patients (50.2%) were men. Cancer was active in 174 patients, with 77 (33.3%) patients with metastasis and 58 (25.1%) with recurrence. The most frequent cancer type was lung cancer (n = 42), followed by breast cancer (n = 31) and gastric cancer (n = 28). Within 1 month before the screening, 142 (61.5%) patients received cancer treatment. Cytotoxic chemotherapy was most frequent (n = 91), followed by molecular-targeting therapy (n = 35) and immunotherapy (n = 26). Radiological features were independently reviewed by two radiologists and categorized into the following groups according to the expert consensus statement of the Radiological Society of North America (Simpson et al., 2020Simpson S. Kay F.U. Abbara S. Bhalla S. Chung J.H. Chung M. Henry T.S. Kanne J.P. Kligerman S. Ko J.P. Litt H. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication.J. Thorac. Imaging. 2020; 35: 219-227Crossref PubMed Scopus (457) Google Scholar): negative for pneumonia (Cov19Neg, n = 145, 62.8%), indeterminate appearance or nonspecific features of COVID-19 pneumonia (Cov19Ind, n = 40, 17.3%), atypical appearance or uncommonly reported features of COVID-19 pneumonia (Cov19Aty, n = 34, 14.7%), and typical appearance or commonly reported imaging features of greater specificity for COVID-19 pneumonia (Cov19Typ, n = 12, 5.2%) (Table S1). Based on clinical information and CT findings, 107 patients underwent the PCR test for SARS-COV-2 but no patients got positive results. There were various final diagnoses of symptoms that required screening (Table S1). The most common diagnosis was bacterial pneumonia, including aspiration pneumonia (n = 33, 14.3%), followed by cancer-related conditions such as tumor progression and adverse events due to cancer treatment. However, the specific cause for COVID-19-like symptoms was not identified in approximately one-fourth of patients. We report here the clinical characteristics of 231 patients who underwent screening using chest CT and PCR for SARS-CoV-2. The cornerstone of COVID-19 diagnosis is the PCR test, which varies in sensitivity and may generate false negatives. Thus, multiple studies discuss the combination of PCR and chest CT for increased accuracy of detecting COVID-19. One meta-analysis of 16 studies (n = 3,186) shows that the sensitivity of chest CT was 92% (95%CI, 86%–96%), though the sensitivity of each study depends on the patients' characteristics, such as the severity of pneumonia (Xu et al., 2020Xu B. Xing Y. Peng J. Zheng Z. Tang W. Sun Y. Xu C. Peng F. Chest CT for detecting COVID-19: a systematic review and meta-analysis of diagnostic accuracy.Eur. Radiol. 2020; 30: 5720-5727Crossref PubMed Scopus (160) Google Scholar). In the present study, all patients underwent chest CT to increase the pretest probability of COVID-19 and to facilitate diagnoses. Also, the imaging facility is physically separated from the hospital, which prevents virus transmission. Despite increasing the pretest probability, we did not detect any positive cases of COVID-19, suggesting that abnormal CT findings were more associated with multiple causes among cancer patients (Table S1). These findings should serve to caution oncologists that COVID-19-like symptoms and CT findings do not always indicate COVID-19 pneumonia. Because no cases of COVID-19 were detected in our research, we were unable to evaluate the sensitivity and specificity of the combination PCR and chest CT analyses. However, no studies other than ours have focused on the incidence of COVID-19 in symptomatic patients with cancer, and our results were consistent with the low prevalence (around 1%) of COVID-19 in asymptomatic patients reported by cancer hospitals in the United Arab Emirates and the United Kingdom (Al-Shamsi et al., 2020bAl-Shamsi H.O. Coomes E.A. Alrawi S. Screening for COVID-19 in asymptomatic patients with cancer in a hospital in the United Arab Emirates.JAMA Oncol. 2020; https://doi.org/10.1001/jamaoncol.2020.2548Crossref PubMed Scopus (36) Google Scholar; Lee et al., 2020bLee L.Y.W. Hill T. Topping O. Tilby M. Baker M. Greig J. Isherwood L. Miller R. Petrenko Y. Desai R. et al.Utility of COVID-19 screening in cancer patients.Cancer Cell. 2020; 38: 306-307Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar). Our research shows that cancer-associated causes outweighed the possibility of COVID-19 among cancer patients with COVID-19-like symptoms. Although there were no confirmed cases of COVID-19 via PCR, the strategy employing CT and separating patients suspected with COVID-19 facilitated the diagnosis of patients with COVID-19-like symptoms. Appropriate management of separation, screening, and diagnosis in a cancer hospital is required for maintaining cancer treatment during this pandemic era. The hard work of all staff members who participated in the screening processes is appreciated. We thank all members of the COVID-19 Working Group at The Cancer Institute Hospital of Japanese Foundation for Cancer Research: Ai Hirota, Mikako Tanba, Yuko Shirouchi, Takanori Fukuta, Takashi Okabe, Hideki Uryu, Yuko Ishihara, Yuko Mishima, Noriko Nishimura (Department of Hematology Oncology), Daisaku Kamiimabeppu, Taro Sato, Hiroki Osumi, Izuma Nakayama, Takeru Wakatsuki, Akira Oki, Daisuke Takahari, Eiji Shinozaki, Mitsukuni Suenaga, Keisho Chin (Department of Gastroenterological Chemotherapy), Saori Kawai, Jun Masuda (Department of Breast Medical Oncology), Akihiro Ohmoto, Tetsuya Urasaki, Makiko Ono (Department of Medical Oncology), Takaaki Furukawa (Department of Hepato-Biliary-Pancreatic Medicine), Takahiro Kogawa, and Shigehisa Kitano (Center for Advanced Medical Development). Download .xlsx (.04 MB) Help with xlsx files Document S1. Table S1 A Lung Cancer Patient with Dyspnea: Diagnostic Difficulties during the COVID-19 PandemicPruis et al.Cancer CellOctober 9, 2020In BriefIn the COVID-19 pandemic of 2020, patients with cancer appear to be at higher risk for complications of COVID-19 than those without cancer (Bakouny et al., 2020; Garassino et al., 2020). High SARS-CoV-2 viral load has been associated with in-hospital mortality in patients with and without cancer (Westblade et al., 2020). While viral load is predictive of mortality risk, we urge physicians to be aware of the limitations of the current diagnostics tests, especially in patients with underlying pulmonary malignancy and in those on treatments that can result in interstitial lung disease (ILD). Full-Text PDF Open Archive

PURPOSE:To predict the histologic invasiveness of pure GGNs using the maximum CT value. PATIENTS AND METHODS:One hundred eighty patients underwent a resection of pure GGNs. On preoperative CT imaging studies, we selected the axial section that showed the densest component of each GGN. The CT value was measured using a DICOM (Digital Imaging and Communication in Medicine) viewer, excluding portions of vessels and bronchi. The correlation between the CT value and GGN histologic diagnosis was analyzed. RESULTS:The numbers of patients with atypical adenomatous hyperplasia, adenocarcinoma-in-situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) were 9, 108, 56, and 7, respectively. One of the IAC tumors exhibited lymphatic invasion, and there were no cases of vascular invasion. In comparison to preinvasive lesions (atypical adenomatous hyperplasia and AIS), invasive lesions (MIA and IAC) were correlated with a higher maximum CT value (-404 ± 113 Hounsfield units [HU] vs. -216 ± 125 HU, P < .01). The cutoff point of maximum CT value was determined at -300 HU using receiver operating characteristic curve analysis, and exhibited sensitivity and specificity of 83% and 88%, respectively. Multivariate analysis revealed that maximum CT value was an independent predictor of histologic invasiveness (odds ratio 39, P < .01). The interobserver reliability was satisfactory (intraclass correlation coefficient, 0.738; unweighted kappa-values, 0.722). CONCLUSION:IAC and MIA accounted for 4% and 31% of the pure GGN lesions, respectively. Higher maximum CT value (≥ -300 HU) was a useful predictor of histologic invasiveness.