Diagnostic yield of bronchoscopy in histologically proven invasive pulmonary aspergillosis

Invasive pulmonary aspergillosis (IPA) is a life-threatening infectious com plication in neutropenic patients after high-dose chemotherapy or hematopoi etic stem cell transplantation. Its diagnosis is mainly based on clinical s ymptoms, and radiological signs on thoracic CT scan. The value of bronchosc opy is controversial. We analyzed the diagnostic yield of bronchoscopy in 2 3 consecutive patients with histologically proven invasive pulmonary asperg illosis, In seven patients (30%) bronchoscopically obtained specimens were diagnostic for pulmonary fungal infection. Typical hyphae were detected by cytology in six patients and fungal cultures were positive in four cases. P atients with a positive bronchoscopic result presented more often with mult iple changes on thoracic CT scan (71%; 5/7), but had received a lower media n cumulative dose of amphotericine B (300 mg; 168-3010 mg) compared to pati ents with non-diagnostic bronchoscopy (25% multiple lesions (4/16); amphote ricine dose 1100 mg, 260-2860 mg), The diagnostic yield of bronchoscopy was not associated with clinical symptoms or duration of neutropenia, Bronchos copy allows the diagnosis of IPA in about one third of patients. Fungal cul tures and cytological examination of intrabronchial specimens obtained duri ng bronchoscopy have a high specificity, but its sensitivity is low. It is advisable to perform diagnostic bronchoscopy before starting antifungal the rapy. Better diagnostic tools are urgently needed.