title: Utility of percutaneous lung biopsy for diagnosing filamentous fungal infections in hematologic malignancies.
abstract: OBJECTIVE
  The incidence of invasive filamentous fungal infections in hematologic patients is increasing as a consequence of high dose chemotherapy and bone marrow transplant procedures. Mortality is usually very high. The diagnosis is often difficult and yet a fast, accurate diagnosis is of fundamental importance for treating the infection and planning subsequent management of the hematologic disease. We evaluated the sensitivity of computed tomography (CT)-guided percutaneous biopsy in diagnosing pulmonary fungal infections.
  
  
  METHODS
  Between 1997 and 2002 we performed 17 CT-guided percutaneous transthoracic lung biopsies in 17 hematologic patients with suspected filamentous fungi infection with negative BAL, to obtain a certain diagnosis and to know what species of fungi was responsible for infection. In all cases suspected mycosis began during the post-chemotherapy aplastic period. Patients were receiving antifungal therapy at the time of all biopsies. When the platelet count rose above 50 x 10(9)/L, CT-guided percutaneous lung biopsy with fine-needle aspiration for cytology was performed.
  
  
  RESULTS
  Twelve of 17 patients had histologic confirmation of the fungal infection (70.5%), 8 with Aspergillus spp. 4 with Mucorales spp. Biopsies provided non-specific results in 4 cases; in 2 of these cases, clinical course and response to therapy confirmed the diagnosis of mycosis; in the last case bronchoalveolar carcinoma was found as a new diagnosis. Cultures were positive in only 6 cases, all for Aspergillus spp. The sensitivity of CT-guided percutaneous lung biopsy was 70.6% and its positive predictive value (PPV) was 100%. This procedure provided an immediate diagnosis and only one side-effect (1 pneumothorax, without complications).
  
  
  CONCLUSIONS
  Histologic discrimination between aspergillosis and mucormycosis is very important for deciding secondary prophylaxis during transplant procedures, because Mucor is usually resistant to azoles.
authors.affiliation: Division of Haematology, Dept. of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy. miccaimi@tin.it
authors.forename: Annamaria
authors.initials: A
authors.lastname: Nosari
authors.forename: Michela
authors.initials: M
authors.lastname: Anghilieri
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Carrafiello
authors.forename: Cleofe
authors.initials: C
authors.lastname: Guffanti
authors.forename: Laura
authors.initials: L
authors.lastname: Marbello
authors.forename: Marco
authors.initials: M
authors.lastname: Montillo
authors.forename: Giuliana
authors.initials: G
authors.lastname: Muti
authors.forename: Sonia
authors.initials: S
authors.lastname: Ribera
authors.forename: Alberto
authors.initials: A
authors.lastname: Vanzulli
authors.forename: Michele
authors.initials: M
authors.lastname: Nichelatti
authors.forename: Enrica
authors.initials: E
authors.lastname: Morra
mesh_terms: D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D001230:Aspergillus / Q000302:isolation & purification; D001707:Biopsy, Needle / Q000379:methods*; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D004198:Disease Susceptibility; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009090:Mucorales / Q000302:isolation & purification; D009091:Mucormycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology / Q000473:pathology; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D015641:Radiography, Interventional; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents