To determine the use of coccidioidal serology in evaluating the cause of pulmonary masses or nodules.
At the Tucson VA hospital, we retrospectively reviewed 142 needle biopsies or aspirations (FNA) of pulmonary nodules or masses from July 2001 through June 2003 and concomitant serologic studies (within 3 months) of the FNA. The serologic studies were immunodiffusion tube precipitin antibody (IDTP), immunodiffusion complement fixation antibody (IDCF) and complement fixation titers to Coccidioides antigen. We also reviewed all 86 additional persons diagnosed with pulmonary coccidioidomycosis during the same period.
Of the 142 persons with FNA, all had negative serology. Eighteen had coccidioidomycosis, 92 had cancer, 40 had non-diagnostic FNA and one had histoplasmosis. Of the 86 other persons with pulmonary coccidioidomycosis all were positive by IDCF testing except three who had positive IDTP. Eighteen had a mass or nodule, 38 had pneumonia, 3 had hilar adenopathy, 8 had single cavities, 9 had diffuse disease, and 10 had chronic fibrocavitary disease. Of the 18 persons with a coccidioidal mass or nodule (and positive serology), 9 were know to be post-primary coccidioidal pneumonia. For the other 9, the nodule or mass was of unknown cause. The positive serologic test was evidence that the lesion was due to coccidioidal infection. With over one year follow-up, there was no indication of growth or other evidence of neoplastic disease in these 9 individuals.
Coccidioidal serology is used to evaluate patients with lung nodules or masses in an endemic area. Persons with negative serology are often referred for lung FNA when there is suspicion of cancer. Persons with a positive serology are presumed to have coccidioidal infection as the etiology of the mass or nodule. Although patients with coccidioidal nodules may have negative serology, no patient with cancer had positive serology.
Coccidioidal serology is useful in evaluating lung nodules and masses where coccidioidomycosis is endemic. A positive serologic test for antiboidy is used to help diagnose coccidioidal etiology and to exclude cancer.
Sammy Campbell, None.