The prevalence of pulmonary aspergillosis is increasing because of the growing aged population and the diversity of medical treatments. However, it is not easy to diagnose aspergillosis microbiologically or pathologically. Although we frequently utilize CT-guided fine-needle aspiration (CT-FNA) for diagnosis of pulmonary aspergillosis, the usefulness and safety of the procedure is not well established. In this context, we have conducted a study to clarify the value of CT-FNA for making diagnosis of pulmonary aspergillosis.
We retrospectively reviewed the medical records of the individuals with pulmonary aspergillosis who underwent CT-FNA from April 2003 to March 2005, and analyzed the accuracy and complications of the procedure. We percutaneously punctured the cavitary lesions or infiltrations with chest CT guiding by using 21 or 23 gauges-needle. If no specimen was obtained, small amount of saline (two to five ml) was infused into the lesions and recollected. The specimens were examined microbiologically and cytologically.
Thirteen patients (8 males and 5 females) were enrolled and the mean age was 60.7 years old (41-77 years old). Six patients had been performed thoracic surgery previously and five had sequelae of tuberculosis. Diabetes mellitus and nontuberculous mycobacteriosis were associated with respective three cases. Two had been under medication with corticosteroid or immunosuppressive agents. Before CT-FNA, serial sputum cultures were negative in all cases, and bronchoscopic examinations were not conclusively diagnostic for aspergillosis in three. All patients were punctured successfully and sufficient specimens for the examinations were obtained. Aspergillus was isolated from six cases and five specimens were cytologically positive for Aspergillus. In total, eight of thirteen (61.5%) could be diagnosed pulmonary aspergillosis definitely by CT-FNA. In all patients, CT-FNA were performed without any serious complications such as pneumothorax or bleeding.
CT-FNA is an useful technique in defining diagnosis of pulmonary aspergillosis which could be conducted safely and less invasively.
If pulmonary aspergillosis is clinically suspected but the diagnosis is undetermined, CT-FNA should be considered as the next diagnostic approach.
Masateru Kawabata, None.