Hoffer F A, Gow K, Flynn P M, Davidoff A
Department of Diagnostic Imaging, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA.
Pediatr Radiol. 2001 Mar;31(3):144-52. doi: 10.1007/s002470000402.
Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection.
We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis.
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.
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.
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.
侵袭性肺曲霉病病情凶险，在免疫抑制患者中往往是致命的。经皮活检可筛选出可能从手术切除中获益的患者。
我们试图确定经皮活检对儿童侵袭性肺曲霉病的诊断准确性。
我们回顾性分析了24例疑似肺曲霉病儿童患者的28次影像引导下经皮肺活检。其中22例正在接受恶性肿瘤治疗，2例患有先天性免疫缺陷；15例接受了骨髓移植。经皮肺活检的准确性通过后续手术切除、尸检或临床病程来确定。
组织病理学研究显示，10份活检标本有分隔菌丝，提示为霉菌，7份培养有黄曲霉菌落。其余18份活检未发现真菌。活检结果为阴性的患者均未发生进行性曲霉病。经皮活检检测侵袭性肺霉菌的敏感性为100%（10/10），特异性为100%（18/18）。经皮活检结果在86%（28例中的24例）的病例中影响了手术决策。46%（13/28）的活检出现出血并发症，其中1例出血加速了患者死亡。
经皮肺活检是诊断侵袭性肺曲霉病的一种准确技术，并能正确判断哪些免疫抑制儿童患者将从治疗性肺切除中获益。
