Pre-HCT lung computed tomography as an alternative to PFT during the COVID-19 Pandemic

Tamaki, Masaharu; Nakasone, Hideki; Aikawa, Tadao; Nakamura, Yuhei; Kawamura, Masakatsu; Kawamura, Shunto; Takeshita, Junko; Yoshino, Nozomu; Misaki, Yukiko; Yoshimura, Kazuki; Matsumi, Shinpei; Gomyo, Ayumi; Tanihara, Aki; Kusuda, Machiko; Akahoshi, Yu; Kimura, Shun-ichi; Kako, Shinichi; Oyama-Manabe, Noriko; Kanda, Yoshinobu

The pulmonary function test (PFT) is an important test for risk stratification before allogeneic transplantation (allo-HCT). However, it might be preferable to avoid PFT as much as possible in the recent era of coronavirus disease 2019 (COVID-19), because PFT requires forced expirations and might produce aerosol, increasing the risk of COVID-19 transmission. Therefore, we tried to predict normal PFT results before allo-HCT based on computed tomography (CT) findings. This study included 390 allo-HCT recipients at our center for whom lung CT images and PFT results before allo-HCT were available. Abnormal CT findings were less likely to be observed in the normal PFT group (47.0% vs 67.4%, P = 0.015), with a high negative predictive value of 92.9%. In a multivariate analysis, normal CT was significantly associated with normal PFT (odds ratio 2.47 (95% CI 1.22 – 4.97), P = 0.012). A model for predicting normal PFT was constructed based on the results of a multivariate analysis and the area under the curve of the receiver operating characteristic analysis was 0.656, which gave a sensitivity of 45.5% and a specificity of 86.0%. The relatively high specificity of the model suggested that PFT can be omitted in patients with normal CT findings before allo-HCT.