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SARS-CoV-2 Nasopharyngeal Swab Testing—False-Negative Results From a Pervasive Anatomical Misconception

Educational Objective
To understand how an anatomical misconception can contribute to false-negative results in SARS-CoV-2 Nasopharyngeal Swab testing
1 Credit CME

A qualitative real-time polymerase chain reaction of nasopharyngeal secretions is the criterion standard for identifying respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 However, major concerns have been raised regarding the rates of false-negative results in community testing locations.2 In an early retrospective review of community hospital testing in China, a sensitivity of only 71% was reported.3 Although there are many sources of false-negative results—including laboratory errors, patient misidentification, and inadequate collection of secretions—improper technique resulting in swabs not reaching the target site of the nasopharynx is a pervasive but modifiable error.

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Article Information

Corresponding Author: Thomas S. Higgins, MD, MSPH, Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, 6420 Dutchmans Pkwy, Ste 380, Louisville, KY 40205 (thomas.higgins@louisville.edu).

Published Online: September 17, 2020. doi:10.1001/jamaoto.2020.2946

Conflict of Interest Disclosures: Dr Higgins reported being a paid research investigator for Optinose and Gossamer and receiving personal fees from Sanofi-Regeneron and Genentech outside the submitted work. Dr Wu reported receiving payment for positions as a speaker for Sanofi-Regeneron and Optinose, a member of a medical advisory board for Optinose and Gossamer, and an investigator for Gossamer outside the submitted work. No other disclosures were reported.

References
1.
Centers for Disease Control and Prevention. Interim guidelines for collecting, handling, and testing clinical specimens for COVID-19: interim guidelines for collecting, handling, and testing clinical specimens from persons for coronavirus disease 2019 (COVID-19). Coronavirus Disease 2019 (COVID-19) website. Accessed May 14, 2020. https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html
2.
West  CP , Montori  VM , Sampathkumar  P .  COVID-19 testing: the threat of false-negative results.   Mayo Clin Proc. 2020;95(6):1127-1129.doi:10.1016/j.mayocp.2020.04.004PubMedGoogle ScholarCrossref
3.
Fang  Y , Zhang  H , Xie  J ,  et al.  Sensitivity of chest CT for COVID-19: comparison to RT-PCR.   Radiology. 2020;296(2):E115-E117.doi:10.1148/radiol.2020200432PubMedGoogle ScholarCrossref
4.
Wang  W , Xu  Y , Gao  R ,  et al.  Detection of SARS-CoV-2 in different types of clinical specimens.   JAMA. 2020;323(18):1843-1844. doi:10.1001/jama.2020.3786PubMedGoogle Scholar
5.
Tunsjø  HS , Berg  AS , Inchley  CS , Røberg  IK , Leegaard  TM .  Comparison of nasopharyngeal aspirate with flocked swab for PCR-detection of respiratory viruses in children.   APMIS. 2015;123(6):473-477. doi:10.1111/apm.12375PubMedGoogle ScholarCrossref
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