The Utility of Chest X-ray vs Computed Tomography in Febrile Neutropenic Patients Presenting to Oncology Unit of the Tertiary are Hospital.
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Abstract
Objective: Our study aimed at comparing the performance of high-resolution computed tomography (HRCT) and chest X-ray (CXR) in diagnosing febrile-neutropenic (FN) patients having childhood malignancies.
Methodology: This cross-sectional, prospective study included children having febrile neutropenia who had malignancies presenting at the pediatric oncology unit of Combined Military Hospital, Rawalpindi from 1st January 2022 to 30th June 2023. Total 114 children, up to 18 years having fever of 38.2°C or more and absolute neutrophil count <1000/µl, were included. Chest x-ray and HRCT were done to document the pulmonary lesions and findings were compared.
Results: CXR findings were normal in 64.9% and abnormal in 35.1%, while 84.2% had abnormal findings on HRCT and 15.8% were normal (p=0.001). HRCT findings were statistically significant in patients with ANC≤0.5 as compared to ANC >0.5 (p=0.005).
Conclusion: HRCT is supercilious to CXR in determining pulmonic lesions in patients with febrile neutropenia. In severe neutropenic patients with fever, irrespective of respiratory symptoms, HRCT should be done. It can help to initiate timely proper treatment and reduce the morbidity and mortality.
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References
1. Davis K, Wilson S. Febrile neutropenia in paediatric oncology. Paediatr Child Health (Oxford). 2020;30(3):93–97. doi:10.1016/j.paed.2019.12.002.
2. Osone S, Shinoda K, Yamamoto N, Suzuki K, Yano M, Ishida Y, et al. Current methods of preventing infectious disease and managing febrile neutropenia in childhood cancer patients: a nationwide survey in Japan. Int J Clin Oncol. 2023;28(2):331–340. doi:10.1007/s10147-022-02282-x.
3. James V, Prakash A, Mehta K, Durugappa T, et al. Re-thinking treatment strategies for febrile neutropenia in paediatric oncology population: the perspective from a developing country. Infect Agents Cancer. 2021;16(1):44. doi:10.1186/s13027-021-00387-y.
4. Bochennek K, Hogardt M, Lehrnbecher T. Immune signatures, testing, and management of febrile neutropenia in pediatric cancer patients. Expert Rev Clin Immunol. 2023;19(3):267–277. doi:10.1080/1744666X.2023.2168646.
5. Roberts SD, Wells GM, Gandhi NM, York NR, Maron G, Razzouk B, et al. Diagnostic value of routine chest radiography in febrile, neutropenic children for early detection of pneumonia and mould infections. Support Care Cancer. 2012;20(10):2589–2594. doi:10.1007/s00520-011-1366-7.
6. Hwang EJ, Lee JH, Kim JH, Lim WH, Goo JM, Park CM. Deep learning computer-aided detection system for pneumonia in febrile neutropenia patients: a diagnostic cohort study. BMC Pulm Med. 2021;21(1):406. doi:10.1186/s12890-021-01768-0.
7. Khorasanizadeh F, Kaviani S, Salamroudi S, Seyyedsalehi MS, Gity M, Zendehdel K. Role of chest CT scan in patients with preexisting cancer and COVID-19 pneumonia. BMC Med Imaging. 2023;23:27. doi:10.1186/s12880-023-00984-w.
8. Kang M, Deoghuria D, Varma S, Gupta D, Bhatia A, Khandelwal N. Role of HRCT in detection and characterization of pulmonary abnormalities in patients with febrile neutropenia. Lung India. 2013;30(2):124–130. doi:10.4103/0970-2113.110420.
9. Kim HJ, Park SY, Lee HY, Lee KS, Shin KE, Moon JW. Ultra-low-dose chest CT in patients with neutropenic fever and hematologic malignancy: image quality and diagnostic performance. Cancer Res Treat. 2014;46(4):393–402. doi:10.4143/crt.2013.132.
10. Barbi E, Marzuillo P, Neri E, Naviglio S, Krauss BS. Fever in children: pearls and pitfalls. Children (Basel). 2017;4(9):81. doi:10.3390/children4090081.
11. Kebudi R, Kizilocak H. Febrile neutropenia in children with cancer: approach to diagnosis and treatment. Curr Pediatr Rev. 2018;14(3):204–209. doi:10.2174/1573396314666180508121625.
12. Das CK, Gogia A, Kumar L, Sharma A, Thulkar S, Xess I, et al. Evaluation of pulmonary infiltrate in febrile neutropenic patients of hematologic malignancies. Indian J Med Paediatr Oncol. 2019;40:386–390. doi:10.4103/ijmpo.ijmpo_39_18.
13. Voulgaridou A, Athanasiadou KI, Athanasiadou E, Roilides E, Papakonstantinou E. Pulmonary infectious complications in children with hematologic malignancies and chemotherapy-induced neutropenia. Diseases. 2019;8(3):32. doi:10.3390/diseases8030032.
14. Green LL, Goussard P, van Zyl A, Kidd M, Kruger M. Predictive indicators to identify high-risk paediatric febrile neutropenia in paediatric oncology patients in a middle-income country. J Trop Pediatr. 2018;64(5):395–402. doi:10.1093/tropej/fmx082.
15. Zaleska-Dorobisz U, Olchowy C, Łasecki M, Sokołowska-Dąbek D, Pawluś A, Frączkiewicz J, et al. Low-dose computed tomography in assessment of pulmonary abnormalities in children with febrile neutropenia suffering from malignant diseases. Adv Clin Exp Med. 2017;26(4):695–701. doi:10.17219/acem/68292.
16. Majzoub IE, Zakhem AE, Cheaito RC, Cheaito MA, Kaddoura R, Alkozah M, et al. Utility of chest X-ray versus computed tomography in febrile neutropenia patients presenting to the emergency department. J Infect Dev Ctries. 2020;14(10):1178–1184. doi:10.3855/jidc.12577.
17. Burivong W, Sricharoen T, Thachang A, Soodchuen S, Maroongroge P, Leelasithorn V. Early radiologic diagnosis of pulmonary infection in febrile neutropenic patients: comparison of serial chest radiography and single CT chest. Radiol Res Pract. 2021;2021:8691363. doi:10.1155/2021/8691363.
18. Gerritsen MG, Willemink MJ, Pompe E, van der Bruggen T, van Rhenen A, Lammers JW, et al. Improving early diagnosis of pulmonary infections in patients with febrile neutropenia using low-dose chest computed tomography. PLoS One. 2017;12(2):e0172256. doi:10.1371/journal.pone.0172256.