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Robotic-Assisted Bronchoscopy and Pulmonary Nodules Due to Atypical Infections in Coccidioidomycosis Endemic Area
Robert Lee1, Selina Deanda2, Wali Zaidi3
1UC Health Parkview Medical Center, Pueblo, CO.
Background:
Although robotic-assisted bronchoscopy (RAB) primarily aims to diagnose early stage lung cancer, many pulmonary nodules stem from benign causes, including atypical infections (ie, Coccidioides species, Aspergillus species, nontuberculous mycobacteria). Data on prevalence of atypical infections in patients undergoing RAB with biopsy of pulmonary nodules are limited.
Research Question:
What is the prevalence of atypical and bacterial infections in patients undergoing robotic-assisted bronchoscopy with biopsy of pulmonary nodules in a coccidioidomycosis endemic area?
Study Design And Methods:
This single-center, retrospective study examined 526 patients who underwent RAB with a shape-sensing platform at our institution from June 2021 through December 2023.
Results:
Of the 526 patients, 261 (49.6%) had malignancy without infection, 107 (20.3%) had cultures positive for infection without malignancy, and 35 (6.65%) were diagnosed with both malignancy and a coexisting bacterial and/or atypical infection. Coccidioides serology (IgG) or clinical history was significantly more prevalent in the infection without malignancy group (32.7%) and the malignancy with infection group (42.9%) compared with the malignancy-only group (0%; P < .001). Complication rates (pneumothorax, bleeding, and hospitalization) did not differ significantly between groups. In a subgroup analysis, 73 patients (13.9%) with granulomatous inflammation on pathology had higher rates of positive fungal (P = .002), Aspergillus (P = .042), and acid-fast bacilli (P < .001) cultures than patients in the nongranuloma group. Positive cultures of acid-fast bacilli, Coccidioides species, or Aspergillus species also had granulomatous inflammation in 76%, 29%, and 29% of cases, respectively. Fifty-two patients had > 1 positive culture result.
Interpretation:
This study highlights the importance of obtaining bronchoscopy cultures in patients undergoing RAB, especially when rapid on-site evaluation of the pulmonary nodule biopsy does not reveal malignancy.
