ROLE OF FIBEROPTIC BRONCHOSCOPY IN THE DIAGNOSIS OF INVASIVE PULMONARY ASPERGILLOSIS IN PATIENTS WITH ACUTE-LEUKEMIA

The utility and safety of fiberoptic bronchoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia have not been examined. The results of 21 bronchoscopic procedures in 19 patients with invasive pulmonary aspergillosis and acute leukemia were reviewed. Analysis was confined to the 16 patients who had histopathologically documented infection on biopsy or at autopsy. Fiberoptic bronchoscopy established or suggested the diagnosis of invasive pulmonary aspergillosis in 8 of 16 (50%) patients. Transbronchial or bronchial biopsy added only 1 diagnosis to those obtained by bronchial washing and brushing. Although fiberoptic bronchoscopy was a safe and well-tolerated procedure in these patients its success rate was only 50% overall and it appeared to be even less successful when performed early in the course of the disease. Fiberoptic bronchoscopy is a useful 1st procedure for the evaluation of patients with acute leukemia and possible invasive pulmonary aspergillosis, but a negative result does not exclude aspergillosis. Further diagnostic procedures, including repeated bronchoscopy, or institution of empiric antifungal therapy may be warranted if the clinical suspicion of invasive pulmonary aspergillosis is high.