Experience with needle biopsy for coccidioidal lung nodules.

Area of Science:

• Pulmonary Medicine
• Infectious Diseases
• Mycology

Background:

• Solitary pulmonary nodules require accurate diagnosis.
• Coccidioidomycosis is an endemic fungal infection presenting diagnostic challenges.
• Needle biopsy is a common diagnostic tool for pulmonary lesions.

Purpose of the Study:

• To evaluate the diagnostic utility of smears and cultures from needle biopsy specimens for solitary coccidioidal granuloma.
• To determine diagnostic methods for patients with unclear initial biopsy results.
• To assess the cost-effectiveness of cultures in diagnosing coccidioidomycosis.

Main Methods:

• Retrospective analysis of 348 patients with solitary pulmonary nodules undergoing needle biopsy.
• Microscopic examination of smears for Coccidioides immitis spherules.
• Fungal cultures of biopsy specimens.
• Review of diagnostic workup for patients without definitive initial diagnosis.

Main Results:

• Coccidioides immitis spherules identified in 49 of 96 patients with coccidioidomas.
• Positive culture yield was 8.6% (3 of 35 biopsy-proven coccidioidal lesions).
• Cultures proved cost-effective in nondiagnostic cases.

Conclusions:

• Needle biopsy smears are valuable for diagnosing solitary coccidioidal granuloma.
• Fungal cultures, despite low yield, are cost-effective and essential for confirming coccidioidomycosis.
• Delaying thoracotomy until culture results are available is recommended when other findings suggest a benign diagnosis.