Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Yonsei Med J. 2020 Aug;61(8):670-678. doi: 10.3349/ymj.2020.61.8.670.
The diagnosis of pulmonary fungal infections is challenging due to the difficulty of obtaining sufficient specimens. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) needle rinse fluid has become an emerging diagnostic material. This study evaluated the role of routine fungal culture from EBUS-TBNA needle rinse fluid, in addition to histopathologic examination and fungal culture of EBUS-TBNA core tissue, in the diagnosis of pulmonary fungal infections.
Among patients who underwent EBUS-TBNA, those with results for at least one of three tests (histopathologic examination, fungal culture of EBUS-TBNA core tissue or needle rinse fluid) were included. Patients with a positive test were divided into two groups (clinical fungal infection and suspected fungal contamination) according to their clinical assessment and therapeutic response to antifungal.
Of 6072 patients, 41 (0.7%) had positive fungal tests and 9 (22%) were diagnosed as clinical fungal infection. Of the 5222 patients who were evaluated using a fungal culture from EBUS-TBNA needle rinse fluid, 35 (0.7%) had positive results. However, only 4 out of 35 (11.4%) were classified as clinical fungal infection. Positive results were determined in 4 of the 68 (5.9%) evaluated by a fungal culture of EBUS-TBNA core tissue, and all were diagnosed as clinical fungal infection.
Routine fungal culture of EBUS-TBNA needle rinse fluid is not useful due to the low incidence of fungal infection and high rate of contamination. However, fungal culture of EBUS-TBNA core tissue and needle rinse fluid should be considered in patients with clinically suspected fungal infection.
由于难以获得足够的标本，肺部真菌感染的诊断具有挑战性。支气管内超声引导经支气管针吸活检（EBUS-TBNA）针冲洗液已成为一种新兴的诊断材料。本研究评估了除 EBUS-TBNA 核心组织的组织病理学检查和真菌培养外，常规从 EBUS-TBNA 针冲洗液中进行真菌培养在肺部真菌感染诊断中的作用。
在接受 EBUS-TBNA 的患者中，纳入了至少有三种检查（组织病理学检查、EBUS-TBNA 核心组织或针冲洗液的真菌培养）之一结果阳性的患者。根据临床评估和对抗真菌药物的治疗反应，将阳性患者分为两组（临床真菌感染和疑似真菌污染）。
在 6072 名患者中，有 41 名（0.7%）真菌检测阳性，其中 9 名（22%）被诊断为临床真菌感染。在评估了 5222 名患者的 EBUS-TBNA 针冲洗液真菌培养结果中，有 35 名（0.7%）为阳性。然而，只有 4 名（11.4%）被归类为临床真菌感染。在评估的 68 名患者中，有 4 名（5.9%）EBUS-TBNA 核心组织真菌培养阳性，且均被诊断为临床真菌感染。
由于真菌感染发生率低且污染率高，常规 EBUS-TBNA 针冲洗液真菌培养无意义。然而，对于临床疑似真菌感染的患者，应考虑进行 EBUS-TBNA 核心组织和针冲洗液的真菌培养。
