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A Simplified Imaging and Serological Approach for Diagnosing Pulmonary Aspergilloma in Surgical Cases
Yasoo Sugiura1, Yohji Matsusaka2, Toshinori Hashizume1
1Department of General Thoracic Surgery, National Hospital Organization, Kanagawa Hospital.
Background:
Simple pulmonary aspergilloma (SPA) in chronic pulmonary aspergillosis (CPA) is characterized by a ball-like lesion within a pre-existing lung cavity. The detection rate of Aspergillus in cultures is low. There are no established clinical diagnostic methods specifically focused on SPA indicated for surgery. This study aimed to develop a simple and reliable diagnostic approach by integrating imaging and serological findings.
Methods:
A retrospective study was conducted on 15 patients with ball-like lesions in lung cavities who underwent lung resection. Four imaging characteristics of CPA (cavity wall thickening, infiltrative shadow around the cavity, air crescent sign, and Monod sign) and three serological markers (elevated β-D-glucan, positive Aspergillus antibody, and positive Aspergillus antigens) were evaluated for their sensitivity and specificity. Positive likelihood ratio (PLR) was calculated. Two high-PLR factors-one from imaging and one from serology-were combined to construct a simplified diagnostic approach.
Results:
Of the 15 patients, 7 were diagnosed with aspergilloma, 3 with lung cancer and 5 with other diseases. The two factors with the highest PLR were Aspergillus IgG antibody and cavity wall thickening. The combination was analyzed with Fisher's exact test with a sensitivity of 71.4%, specificity of 87.5% and a p-value of 0.041.
Conclusion:
This study demonstrated that combining Aspergillus IgG antibody and cavity wall thickening provides a simple and reliable approach to distinguish aspergilloma from other cavitary lung lesions.
Insights
Diagnosing simple pulmonary aspergilloma (SPA) is challenging. Combining Aspergillus IgG antibody tests with cavity wall thickening imaging offers a reliable method to differentiate SPA from other lung conditions.
Area of Science:
- Pulmonology
- Medical Diagnostics
- Infectious Diseases
Background:
- Simple pulmonary aspergilloma (SPA) is a lesion within lung cavities in chronic pulmonary aspergillosis (CPA).
- Current diagnostic methods for SPA, especially for surgical cases, lack specificity, and Aspergillus culture detection rates are low.
- There is a need for improved diagnostic approaches integrating imaging and serological data.
Purpose of the Study:
- To develop a simple and reliable diagnostic approach for simple pulmonary aspergilloma (SPA).
- To integrate imaging and serological findings for improved diagnostic accuracy.
- To differentiate SPA from other lung cavity lesions.
Main Methods:
- A retrospective study of 15 patients with lung cavity lesions undergoing resection.
- Evaluation of four imaging characteristics (cavity wall thickening, infiltrative shadow, air crescent sign, Monod sign) and three serological markers (β-D-glucan, Aspergillus antibody, Aspergillus antigens).
- Calculation of Positive Likelihood Ratio (PLR) and combination of high-PLR imaging and serological factors for a simplified diagnostic approach.
Main Results:
- Of 15 patients, 7 had aspergilloma, 3 lung cancer, and 5 other diseases.
- Aspergillus IgG antibody and cavity wall thickening showed the highest PLR.
- The combined approach achieved 71.4% sensitivity and 87.5% specificity (p=0.041).
Conclusions:
- Combining Aspergillus IgG antibody and cavity wall thickening is a simple and reliable diagnostic strategy.
- This approach aids in distinguishing aspergilloma from other cavitary lung lesions.
- The findings support the integration of serological and imaging data for diagnosing SPA.
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