Relationship between bronchial cytology specimens with abnormal background and pulmonary aspergillosis

Abstract

Objective: Bronchial brush and bronchoalveolar lavage cytology specimens (collectively, bronchial cytology specimens) were reviewed to establish highly sensitive diagnosis of pulmonary aspergillosis.
Study Design: Among bronchial cytology specimens showing inflammation with neutrophils and/or necrosis, we first screened hyphae and calcium oxalate crystals, followed by immunofluorescence fungal staining and electron microscopic observation.
Results: We detected 27 cases of pulmonary aspergillosis and 2 of pulmonary actinomycosis from 148 specimens with inflammatory and/or necrotic backgrounds. Among 29 cases, only 13 were diagnosed by conventional Papanicolaou staining, whereas 16 required immunofluorescence fungal staining. The presence of calcium oxalate crystals was helpful in detecting suspected aspergillosis in 3 of the 29. Electron microscopy showed thin, ruptured fungal walls, which would account for less effective Papanicolaou staining.
Conclusion: To diagnose pulmonary aspergillosis efficiently, it is important to find calcium oxalate crystals first when examining bronchial cytology specimens with inflammation and necrosis, then to add immunofluorescence fungal staining.