Diagnostic success of bronchoscopic biopsy in immunocompromised patients with acute pulmonary disease: predictive value of disease distribution as shown on CT.

Abstract

The purpose of the study was to determine if the distribution of pulmonary opacities on CT scans could be used to predict the outcome of bronchoscopic biopsy procedures in immunocompromised non-AIDS patients with acute pulmonary complications. Thirty-three consecutive immunocompromised patients without AIDS who had acute pulmonary complications and who had had CT, bronchoscopic biopsy procedures, and proved diagnoses were included in the study. The distribution and dominant pattern of pulmonary opacities on CT were assessed independently by two observers. The pathologic diagnoses were invasive aspergillosis (eight), Candida pneumonia (six), bronchiolitis obliterans with or without organizing pneumonia (six), drug-induced lung disease (four), Pneumocystis carinii pneumonia (four), cytomegalovirus pneumonia (three), pulmonary hemorrhage (one), and recurrent lymphoma (one). The results of bronchoscopic techniques established a specific diagnosis in 17 patients (52%). In the remaining 16 patients, results of bronchoscopic biopsy could not be used to establish a specific diagnosis; open lung biopsy (15 patients) or transthoracic needle biopsy (one patient) were required for diagnosis. The results of bronchoscopic procedures were diagnostic more often in patients in whom pulmonary opacities involved the central third of the lung than in patients in whom the central third was spared (70% vs 23%, p = .02). Results were diagnostic more often in cases in which the causes of acute pulmonary complications were infectious than in cases in which the causes were noninfectious (71% vs 17%, p < .005). We conclude that the presence or absence of central disease as shown by CT can be used to suggest whether results of bronchoscopic procedures in immunocompromised non-AIDS patients will be diagnostic.