Utility of percutaneous lung biopsy for diagnosing filamentous fungal infections in hematologic malignancies.
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.
Nosari
Annamaria
A
Division of Haematology, Dept. of Hematology, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milan, Italy. miccaimi@tin.it
Anghilieri
Michela
M
Carrafiello
Gianpaolo
G
Guffanti
Cleofe
C
Marbello
Laura
L
Montillo
Marco
M
Muti
Giuliana
G
Ribera
Sonia
S
Vanzulli
Alberto
A
Nichelatti
Michele
M
Morra
Enrica
E
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
D000935:Antifungal Agents