Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis.
BACKGROUND
Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection.


OBJECTIVE
We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis.


METHODS
We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course.


RESULTS
Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100% (10/10) sensitivity and 100% (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86% (24 of 28) of the cases. Bleeding complicated the biopsy in 46% (13/28) and hastened one death.


CONCLUSIONS
Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection.
Hoffer
F A
FA
Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. fred.hoffer@stjude.org
Gow
K
K
Flynn
P M
PM
Davidoff
A
A
D001228:Aspergillosis / Q000473:pathology*; D001231:Aspergillus flavus; D001707:Biopsy, Needle; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000473:pathology*; D009894:Opportunistic Infections / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed