High prevalence of peribronchial focal lesions of airway invasive aspergillosis in hematological cancer patients with prolonged neutropenia

• DOI: 10.1259/bjr.20190693
• Publication Date: 2020-05-28T09:57:36Z
• Authors: Alessio Casutt; Jade Couchepin; Anne-Sophie Brunel; Alban Lovis; Pierre-Yves Bochud; Nathalie Keller; Frédéric Lamoth; Catherine Beigelm...
• Keywords: Adult; Invasive Pulmonary Aspergillosis; Male; Neutropenia; Galactose; Bronchial Diseases; Middle Aged; 3. Good health; Mannans; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Hematologic Neoplasms; Bronchoscopy; Prevalence; Humans; Female; Tomography, X-Ray Computed; Biomarkers; Aged; Retrospective Studies

Objective: The aim of this study is to characterize chest CT findings of neutropenic patients with proven/probable invasive pulmonary aspergillosis (IPA).

Methods: Hematological cancer patients admitted to our institution (2007–2017) were retrospectively enrolled if the diagnostic criteria of proven/probable IPA during the neutropenia were met (EORTC/MSG). Galactomannan (GM) was routinely measured in serum and chest CT-scan was routinely performed in case of recurrent/persistent fever. Bronchoscopy was performed in case of chest CT-scan abnormalities. Chest CT-scan and GM dosage were analyzed at the time of IPA suspicion. Chest lesions were classified using a clinical report form by two expert radiologists.

Results: 35 patients were identified. Peribronchial focal lesions were observed in 29 IPA (82.9%) by the first radiologist and in 31 (88.5%) by the second (k = 0.768). 12 weeks mortality was 20%.

Conclusion: Peribronchial focal lesions are a common finding in early-IPA whatever the GM value during neutropenia and our findings reinforce the efficiency of a preemptive approach.

Advances in knowledge; Peribronchial focal lesions, which are classically described in airway invasive aspergillosis, are a common finding in early-IPA in hematological cancer patients with prolonged neutropenia regardless of the GM value, and such peribronchial lesions should reinforce the possibility of IPA.