Baseline chest computed tomography as standard of care in high‐risk hematology patients

Abstract

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Baseline chest computed tomography (BCT) in high‐risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web‐based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow‐up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases (n = 69; 49%), hematology (n = 68; 48%), and others (n = 41; 29%). BCT was performed in 57% (n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X‐ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non‐European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5–15%) and non‐BCT centers (7%; IQR 5–10%) (p = 0.69). Follow‐up computed tomography (CT) for IPA was performed in 98% (n = 90) of centers. In high‐risk hematology patients, baseline CT is becoming a standard‐of‐care. Chest X‐ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.