Diagnostic And Prognostic Role Of Chest CT In Oncologic Patients With COVID-19 Pneumonia: An Indian Perspective

Background: In India, cancer patients represent a particularly vulnerable population during the COVID-19 pandemic, owing to compromised immunity and overlapping pulmonary findings from cancer or its treatment. Early and accurate diagnosis of COVID-19 pneumonia in this group is critical but often complicated by pre-existing lung changes. Chest CT, widely used in India as a frontline imaging tool during the pandemic, may provide both diagnostic and prognostic insights. Methods: We retrospectively studied 300 oncologic patients with confirmed COVID-19 between 2020 and 2022 in a tertiary referral hospital in India. Chest CT scans were evaluated using the Radiological Society of North America (RSNA) classification and a CT severity scoring system. Logistic regression was applied to assess the association of CT findings with mortality outcomes. Results: The mean age was 56.5 years, with a slight male predominance (53%). Gastrointestinal (29.3%), hematologic (26.3%), and breast cancers (10.7%) were the most common malignancies. Only 42.8% demonstrated typical COVID-19 imaging features; atypical or indeterminate findings were frequent. Mixed ground-glass opacities with consolidation (44.4%), pleural effusion (33.5%), and pure ground-glass opacities (19.5%) were the most common abnormalities. The overall in-hospital mortality was 27.4%. Mortality risk was higher among patients with typical CT features (OR 3.47; 95% CI 1.14–8.98), CT severity score ≥18 (OR 1.89; 95% CI 1.07–3.34), consolidation (p=0.040), pleural effusion (p<0.001), centrilobular nodules (p=0.013), and architectural distortion (p=0.005). Conclusion: In Indian oncologic patients, less than half of COVID-19 cases showed classical CT patterns. Radiologists must remain alert to atypical and subtle features to avoid underdiagnosis. Certain CT findings, particularly consolidation and pleural effusion, are strongly linked to poorer prognosis. In resource-constrained Indian hospitals, CT can serve as both a diagnostic adjunct and a prognostic tool, guiding timely triage and clinical management.