Carrafiello G, Laganà D, Nosari A M, Guffanti C, Morra E, Recaldini C, D'Alba M J, Sonvico U, Vanzulli A, Fugazzola C
Cattedra di Radiologia, Università degli Studi dell'Insubria, Viale Borri 57, I-21100 Varese, Italy.
Radiol Med. 2006 Feb;111(1):33-41. doi: 10.1007/s11547-006-0004-9.
The purpose of this study was to evaluate the sensitivity of percutaneous computed tomography (CT)-guided lung biopsy in the early diagnosis of fungal pulmonary infections.
Between 1997 and 2003, 18 haematologically immunodeficient patients with suspected filamentous fungi infection and negative bronchoalveolar lavage (BAL) underwent percutaneous pulmonary biopsy to diagnose the nature of the infection. In all cases, infection developed during the post-chemotherapy bone marrow aplasia period.
Thirteen out of 18 patients had histologic findings positive for fungal infection: 8 Aspergillus and 5 Mucor. In 3 cases, biopsy was not specific, and in one case, the tissue sample was inadequate for a diagnosis; however, clinical course and response to drugs were compatible with fungal infection. In one patient, biopsy was positive for bronchoalveolar carcinoma. The sensitivity of percutaneous CT-guided biopsy was 80% and its positive predictive value was 100%. We only had one pneumothorax as a complication.
Percutaneous CT-guided lung biopsy is an easy, safe and reliable procedure to obtain diagnostic material. Histological discrimination between Aspergillus and Mucor is important in order to plan the correct therapeutic protocols, as Mucor is usually resistant to azoles.
本研究旨在评估经皮计算机断层扫描（CT）引导下肺活检在真菌性肺部感染早期诊断中的敏感性。
1997年至2003年间，18例血液学免疫缺陷且怀疑丝状真菌感染但支气管肺泡灌洗（BAL）结果为阴性的患者接受了经皮肺活检以明确感染性质。所有病例均在化疗后骨髓再生障碍期发生感染。
18例患者中有13例组织学检查结果显示真菌感染阳性：8例为曲霉菌感染，5例为毛霉菌感染。3例活检结果不具有特异性，1例组织样本不足以做出诊断；然而，临床病程及对药物的反应与真菌感染相符。1例患者活检结果显示为支气管肺泡癌。经皮CT引导下活检的敏感性为80%，阳性预测值为100%。我们仅出现1例气胸并发症。
经皮CT引导下肺活检是获取诊断材料的一种简便、安全且可靠的方法。区分曲霉菌和毛霉菌的组织学特征对于制定正确的治疗方案很重要，因为毛霉菌通常对唑类药物耐药。
