Document Type : Review Articles


1 Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

2 Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

4 Student of Research Committee, Department of Pediatrics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran

5 Research Center for Health Sciences, Institute of Health, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz


Backgrounds:  Given the novelty of COVID-19, reviewing diagnostic methods can be of great help to community health policymakers. Considering the importance of diagnosing COVID-19 and the need for reducing the number of false positive and false negative cases that appear to be different in various diagnostic methods, this systematic review aimed at comparison of PCR test accuracy with laboratory data and CT SCAN in COVID-19.
Methods: In this systematic review, EMBASE (Elsevier, 2018), MEDLINE (National Library of
Medicine, 2018), Scopus, ProQuest, Web of Science (Clarivate Analytics, 2018b), and Google Scholar
data bases were searched for the studies published prior to 3 April 2020. Based on the inclusion criteria, 20 out of 859 primarily screened studies were finally assessed.
Results: The results indicated that the laboratory diagnosis of viral nucleic acid could have false-negative results, and serological testing of virus-specific IgG and IgM antibodies should be used as an option for diagnosis. Moreover, chest Computerized Tomography (CT) was found to be more sensitive in comparison toReverse Transcription Polymerase Chain Reaction (RT-PCR) (98% vs. 71%). Hence, the articles offered the combined use of chest CT, SARS-CoV-2 RT-PCR, and multi-plex PCR. 
Conclusions: Follow-up RT-PCR and chest CT are necessary in COVID-19. In addition, serological testing of virus-specific IgG and IgM antibodies along with laboratory diagnosis of viral nucleic acid can lead to the highly sensitive and accurate diagnosis. Moreover, Enzyme-Linked Immunosorbent Assay (ELISA) is one of the cost-effective methods in epidemic conditions in low- and middle-income countries.


1.            Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506.
2.            Wong HYF, Lam HYS, Fong AH-T, Leung ST, Chin TW-Y, Lo CSY, et al. Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients. Radiology. 2020:201160.
3.            Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine. 2020.
4.            WHO main website. Accessed March 12th.
5.            Bellau-Pujol S, Vabret A, Legrand L, Dina J, Gouarin S, Petitjean-Lecherbonnier J, et al. Development of three multiplex RT-PCR assays for the detection of 12 respiratory RNA viruses. Journal of virological methods. 2005;126(1-2):53-63.
6.            Tiveljung‐Lindell A, Rotzén‐Östlund M, Gupta S, Ullstrand R, Grillner L, Zweygberg‐Wirgart B, et al. Development and implementation of a molecular diagnostic platform for daily rapid detection of 15 respiratory viruses. Journal of medical virology. 2009;81(1):167-75.
7.            Gunson R, Collins T, Carman W. Practical experience of high throughput real time PCR in the routine diagnostic virology setting. Journal of Clinical Virology. 2006;35(4):355-67.
8.            Garbino J, Gerbase MW, Wunderli W, Kolarova L, Nicod LP, Rochat T, et al. Respiratory viruses and severe lower respiratory tract complications in hospitalized patients. Chest. 2004;125(3):1033-9.
9.            Lee BE, Robinson JL, Khurana V, Pang XL, Preiksaitis JK, Fox JD. Enhanced identification of viral and atypical bacterial pathogens in lower respiratory tract samples with nucleic acid amplification tests. Journal of medical virology. 2006;78(5):702-10.
10.          Oosterheert JJ, Van Loon AM, Schuurman R, Hoepelman AI, Hak E, Thijsen S, et al. Impact of rapid detection of viral and atypical bacterial pathogens by real-time polymerase chain reaction for patients with lower respiratory tract infection. Clinical infectious diseases. 2005;41(10):1438-44.
11.          Lam W, Yeung AC, Tang JW, Ip M, Chan EW, Hui M, et al. Rapid multiplex nested PCR for detection of respiratory viruses. Journal of clinical microbiology. 2007;45(11):3631-40.
12.          Wallace LA, McAulay KA, Douglas JD, Elder AG, Stott DJ, Carman WF, et al. Influenza diagnosis: from dark isolation into the molecular light. Journal of Infection. 1999;39(3):221-6.
13.          Penson DF, Krishnaswami S, Jules A, Seroogy JC, McPheeters ML. Evaluation and treatment of cryptorchidism. 2012.
14.          Dong X, Cao Yy, Lu Xx, Zhang Jj, Du H, Yan Yq, et al. Eleven faces of coronavirus disease 2019. Allergy. 2020.
15.          Jia X, Zhang P, Tian Y, Wang J, Zeng H, Wang J, et al. Clinical significance of IgM and IgG test for diagnosis of highly suspected COVID-19 infection. medRxiv. 2020.
16.          Gao L, Jiang D, Wen X-s, Cheng X-c, Sun M, He B, et al. Prognostic value of NT-proBNP in patients with severe COVID-19. Respiratory research. 2020;21(1):1-7.
17.          Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, et al. Prognostic value of C-reactive protein in patients with COVID-19. medRxiv. 2020.
18.          Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020:200432.
19.          Long C, Xu H, Shen Q, Zhang X, Fan B, Wang C, et al. Diagnosis of the Coronavirus disease (COVID-19): rRT-PCR or CT? European Journal of Radiology. 2020:108961.
20.          Song C-Y, Xu J, He J-Q, Lu Y-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. medRxiv. 2020.
21.          Feng H, Liu Y, Lv M, Zhong J. A case report of COVID-19 with false negative RT-PCR test: necessity of chest CT. Japanese Journal of Radiology. 2020:1-2.
22.          Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020:200642.
23.          Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T, Rucci C, et al. Chest CT features of COVID-19 in Rome, Italy. Radiology. 2020:201237.
24.          Fu H, Xu H, Zhang N, Xu H, Li Z, Chen H, et al. Association between Clinical, Laboratory and CT Characteristics and RT-PCR Results in the Follow-up of COVID-19 patients. medRxiv. 2020.
25.          Ai J-W, Zhang H-C, Xu T, Wu J, Zhu M, Yu Y-Q, et al. Optimizing diagnostic strategy for novel coronavirus pneumonia, a multi-center study in Eastern China. medRxiv. 2020.
26.          Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clinical Infectious Diseases. 2020.