False-positive reverse transcriptase polymerase chain reaction screening for SARS-CoV-2 in the setting of urgent head and neck surgery and otolaryngologic emergencies during the pandemic: Clinical implications

Andrew P Katz, Francisco J Civantos, Zoukaa Sargi, Jason M Leibowitz, Elizabeth A Nicolli, Donald Weed, Alexander E Moskovitz, Alyssa M Civantos, David M Andrews, Octavio Martinez, Giovana R Thomas, Andrew P Katz, Francisco J Civantos, Zoukaa Sargi, Jason M Leibowitz, Elizabeth A Nicolli, Donald Weed, Alexander E Moskovitz, Alyssa M Civantos, David M Andrews, Octavio Martinez, Giovana R Thomas

Abstract

Background: No reports describe falsepositive reverse transcriptase polymerase chain reaction (RT-PCR) for novel coronavirus in preoperative screening.

Methods: Preoperative patients had one or two nasopharyngeal swabs, depending on low or high risk of viral transmission. Positive tests were repeated.

Results: Forty-three of 52 patients required two or more preoperative tests. Four (9.3%) had discrepant results (positive/negative). One of these left the coronavirus disease (COVID) unit against medical advice despite an orbital abscess, with unknown true disease status. The remaining 3 of 42 (7.1%) had negative repeat RT-PCR. Although ultimately considered falsepositives, one was sent to a COVID unit postoperatively and two had urgent surgery delayed. Assuming negative repeat RT-PCR, clear chest imaging, and lack of subsequent symptoms represent the "gold standard," RT-PCR specificity was 0.97.

Conclusions: If false positives are suspected, we recommend computed tomography (CT) of the chest and repeat RT-PCR. Validated serum immunoglobulin testing may ultimately prove useful.

Keywords: COVID-19; RT-PCR; head and neck surgery; pandemic; preoperative testing.

© 2020 Wiley Periodicals, Inc.

References

    1. Adhanom T. WHO Director‐General's Opening Remarks at the Media Briefing on COVID‐10; March 11, 2020. . Accessed May 2, 2020.
    1. State of Florida , Office of the Governor, Executive Order EO 20–72. Emergency Management—Covid‐19—Nonessential Elective Medical Procedures.
    1. Tweet from @Surgeon General, March 14, 2020. Twitter.
    1. Dong E, Du H, Gardner L. An interactive web‐based dashboard to track COVID‐19 in real time. Lancet Infect Dis. 2020;20:533‐534.
    1. Day AT, Sher DJ, Lee RC, et al. Head and neck oncology during the COVID‐19 pandemic: reconsidering traditional treatment paradigms in light of new surgical and other multilevel risks. Oral Oncol. 2020;105:104684. 10.1016/j.oraloncology.2020.104684.
    1. Civantos F, Leibowitz JM, Arnold DJ, et al. Ethical surgical triage of head and neck cancer patients during the COVID‐19 pandemic. Head Neck. 2020. 10.1002/hed.26229.
    1. Zou L, Ruan F, Huang M, et al. SARS‐CoV‐2 viral load in upper respiratory specimens of infected patients. N Engl J Med. 2020;382(12):1177‐1179.
    1. Givi G, Schiff BA, Chinn SB, et al. Safety recommendations for evaluation and surgery of the head and neck during the COVID‐19 pandemic. JAMA Otolaryngol Head Neck Surg. 2020. 10.1001/jamaoto.2020.0780.
    1. Couloigner V, Schmerber S, Nicollas R, et al. COVID‐19 and ENT surgery. Eur Ann Otorhinolaryngol Head Neck. 2020;137(3):161‐166. 10.1016/j.anorl.2020.04.012.
    1. Fakhry N, Schultz P, Morniere S, et al. French consensus on management of head and neck cancer surgery during COVID‐19 pandemic. Eur Ann Otorhinolaryngol Head Neck. 2020;137:159‐160.
    1. Cheng X, Liu J, Li N, et al. Otolaryngology providers must be alert for patients with mild and asymptomatic COVID‐19. Otolaryngol Head Neck Surg. 2020;162(6):809‐810. 10.1177/019459982092064.
    1. Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID‐19. JAMA. 2020;323(14):1406‐1407.
    1. Al‐Tawfiq JA. Asymptomatic coronavirus infection: MERS‐CoV and SARS‐CoV‐2 (COVID‐19). Travel Med Infect Dis. 2020. 10.1016/j.tmaid.2020.101608.
    1. Day M. COVID‐19: four fifths of cases are asymptomatic, China figures indicate. BMJ. 2020;369:1375.
    1. Lai CC, Liu YH, Wang CY, et al. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2): facts and myths. J Microbiol Immunol Infect. 2020;53(3):404‐412. 10.1016/j.jmii.2020.02.012.
    1. Vukkadala N, Qian J, Hoslinger C, Patel ZM, Rosenthal E. COVID‐19 and the otolaryngolist: preliminary evidence‐based review. Laryngoscope. 2020. 10.1002/lary.28672.
    1. Zitek T. The appropriate use of testing for COVID‐19. Western J Emerg Med. 2020;21(3):471‐472.
    1. Ren X, Liu Y, Chen H, et al. Application and optimization of RT‐PCR in diagnosis of SARS‐CoV‐2 infection. medRxiv. 2020. 10.1101/2020.02.25.20027755v2.
    1. Wang W, Xu Y, Gao R, et al. Detection of SARS‐CoV‐2 in different types of clinical specimens. JAMA. 2020;323:1843‐1844.
    1. Center for Disease Control . Coronavirus Disease 2019: Symptoms. . Accessed May 6, 2020.
    1. Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID‐19 infection. EClinical Med. 2020;21:100331. 10.1016/jeclinm.2020.200331.
    1. Tahamtan A, Ardebili A. Real‐time RT‐PCR in COVID‐19 detection: issues affecting the results. Expert Rev Mol Diagn. 2020;20(5):453‐454.
    1. Lin F, Shen Y, Fang C, et al. Incididenc of and factors associated with false positives in laboratory diagnosis of norovirus infection by amplification of the RNA‐dependent RNA polymerase gene. PLoS One. 2014;9(9):1‐7.
    1. Wollants E, Van Ranst M. Detection of false positives with a commonly used norovirus RT‐PCR primer set. J Clin Virol. 2013;56(1):84‐85.
    1. Alm E, Lesko B, Lindegren G, et al. Universal single‐probe RT‐PCR assay for diagnosis of dengue virus infections. PLoS Negl Trop Dis. 2014;8:e3416.
    1. Kim H, Hong H, Yoon SH. Diagnostic performance of CT and reverse transcriptase‐polymerase chain reaction for coronavirus disease 2019: a meta‐analysis. Radiology. 2020. 10.1148/radiol.2020201343.
    1. Hao W, Li M. Clinical diagnostic value of CT imaging in COVID‐19 with multiple negative RT‐PCR testing. Travel Med Infect Dis. 2020;34:101627. 10.1016/j.tmaid.2020.101627.
    1. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT‐PCR testing in coronavirus disease 2019 (COVID‐19) in China: a report of 1014 cases. Radiology. 2020. 10.1148/radiol.2020200642.
    1. Feng H, Liu Y, Lv M, Zhong J. A case report of COVID‐19 with false negative RT‐PCR test: necessity of chest CT. Jpn J Radiol. 2020;38(5):409‐410.
    1. Meng H, Xiong R, He R, et al. CT imaging and clinical course of asymptomatic cases with COVID‐19 pneumonia at admission in Wuhan, China. J Infect. 2020. 10.1016/j.jinf.2020.04.004.
    1. Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID‐19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020;63(5):706‐711. 10.1007/s11427-020-1661-4.

Source: PubMed

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