COVID-19 and early-stage lung cancer both featuring ground-glass opacities: a propensity score-matched study
Yajie Zhang, Wenjie Yang, Dong Liu, Yuqin Cao, Yuyan Zheng, Yichao Han, Runsen Jin, Yu Han, Xiaoyang Wang, Ashan Pan, Jianyi Dai, Qingfeng Sun, Fengquan Zhao, Qingyuan Yang, Jiahao Zhang, Shengjun Liu, Da Qian, Wei Guo, Chengqiang Li, Wentian Zhang, Han Wu, Xingshi Chen, Anqi Ji, Jie Xiang, Kai Chen, Xijia Feng, Xianfei Zhang, Qiqi Cao, Le Qin, Jian Li, Min Zhou, Yong Lu, Chao‐Fu Wang, Fuhua Yan, Hecheng Li, Jieming Qu
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.