Accuracy percutaneous lung biopsy for invasive pulmonary aspergillosis

Background. Invasive pulmonary aspergillosis is fulminant and often fatal i n immunosuppressed patients. Percutaneous biopsy may select patients who co uld benefit from surgical resection. Objective. We sought to determine the accuracy of percutaneous biopsy for p ediatric invasive pulmonary aspergillosis. Materials and methods. We retrospectively reviewed 28 imaging-guided percut aneous biopsies of the lungs of 24 children with suspected pulmonary asperg illosis. Twenty-two were being treated for malignancy and two for congenita l immunodeficiency; 15 had received bone-marrow transplants. The accuracy o f the percutaneous lung biopsy was determined by subsequent surgical resect ion, autopsy, or clinical course. Results. Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in c ulture. The remaining 18 biopsies revealed no fungi. No patient had progres sive aspergillosis after negative biopsy. Invasive pulmonary mold was detec ted by percutaneous biopsy with 100% (10/10) sensitivity and 100% (18/18) s pecificity. Percutaneous biopsy results influenced the surgical decision in 86% (24 of 28) of the cases. Bleeding complicated the biopsy in 46% (13/28 ) and hastened one death. Conclusion. Percutaneous biopsy of the lung is an accurate technique for th e diagnosis of invasive pulmonary aspergillosis and correctly determines wh ich immunosuppressed pe diatric patients would benefit from therapeutic pul monary resection.