Optimizing diagnostic strategy for novel coronavirus pneumonia, a multi-center study in Eastern China

Jing-Wen Ai; Hao-Cheng Zhang; Teng Xu; Jing Wu; Mengqi Zhu; Yi-Qi Yu; Han-Yue Zhang; Zhongliang Shen; Yang Li; Xian Zhou; Guo-Qing Zang; Jie Xu; Wen-Jing Chen; Yong-Jun Li; De-Sheng Xie; Ming-Zhe Zhou; Jing-Ying Sun; Jia-Zhen Chen; Wen-Hong Zhang

Chest computerized tomography (CT) is an important method to identify lung lesions. A study involving 1099 patients have shown that around 76.4% of the laboratory-confirmed SARS-COV-2 patients had novel coronavirus pneumonia (NCP) on admission, and usually exhibited typical radiological finding of the ground-glass opacity (50%) or bilateral patchy shadowing (46%) 11 . However, the specificity of chest CT is relatively low. Currently, the golden standard for the NCP diagnosis is a positive result in real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) assay or metagenomics sequencing for respiratory specimens, including nasal and pharyngeal swab specimens, sputum, and bronchoalveolar lavage fluid 12 . Importantly, RT-PCR is required to be performed at least twice for suspected cases on both admission day 0 and day 2 to achieve two negative results in order for the patients to be released. However, recently, physicians around china has reported cases of NCP that had 2 or even 3 continuous negative RT-PCR results for nasopharyngeal and throat swab specimens before finally laboratory-confirmed 13 . According to the recent "Diagnosis and Treatment Guideline for New Coronavirus Pneumonia (the fifth edition), China", CT imaging results were used as the clinical diagnostic criteria for NCP, but strictly limited in Hubei Province 14 . This phenomenon raised national concerns and discussions about how to improve the diagnostic strategy of novel coronavirus pneumonia (NCP) under the current circumstances.