Late Breaking Abstract - The Role Of Bronchoscopy In Covid-19 Patients During The Sars-Cov-2 Pandemic

Background: During the SARS-CoV-2 pandemic, rapid and reliable diagnosis of COVID-19 is paramount for clinical and infection control reasons. Real-time reverse transcriptase–polymerase chain reaction (rRT-PCR) is considered the gold standard to confirm clinical suspicion. Nasopharyngeal swab (NFS) is commonly used but bronchoalveolar lavage (BAL) specimens show the highest positivity rates of rRT-PCR. Due to its aerosol-generating characteristics, it is advised to postpone bronchoscopy to avoid contamination of healthcare workers. Therefore, little is known about its diagnostic value. Objective: To assess the added diagnostic value of bronchoscopy in COVID-19 patients. Methods: A retrospective analysis of added diagnostic certainty of bronchoscopies carried out at Ghent University Hospital during the epidemic peak in Belgium. Rule in/rule out [Ri/Ro] bronchoscopies in patients with diagnostic uncertainty (repetitive negative NSF swab but high clinical suspicion for COVID-19) were withheld, as well as bronchoscopies in known COVID-19 [Cov+] but suspicious of alternative pathology. Results: Of 31 bronchoscopies performed for diagnostic uncertainty between 19/3 and 30/4/2020, 29 yielded additional diagnostic certainty. Of 26 [Ri/Ro] patients, BAL revealed rRT-PCR positivity in 7, confirmed rRT-PCR negativity in 7 and yielded an alternative microbiological diagnosis in 12. Of 5 [Cov+] patients, 3 had additional microbiological diagnosis. No bronchoscopy-related adverse events or transmission towards involved staff was reported. Conclusion: In suspected COVID-19 cases with diagnostic uncertainty bronchoscopy has an additional diagnostic value with therapeutic consequences provided safety standards are ensured.