Values of CT-guided percutaneous lung biopsy and bronchoalveolar lavage fluid metagenomic next-generation sequencing to the etiologic diagnosis of pulmonary infection
Objective To analyze the results of CT-guided percutaneous lung biopsy and bronchoalveolar lavage fluid(BALF)metagenomic next-generation sequencing(mNGS)in patients with suspected pulmonary infection,and to investigate their values to the etiologic diagnosis of pulmonary infection.Methods Eight patients with suspected pulmonary infection and unconfirmed diagnosis by conventional microbiological test(CMT)underwent CT-guided percutaneous lung biopsy mNGS from June 2020 and May 2021,and those with unconfirmed diagnosis by lung biopsy mNGS underwent BALF-mNGS.The disease history,chest CT examination,results of CMT and mNGS,detection rate of pathogenic microorganisms,treatment and prognosis were recorded.Results Among these 8 patients,2 patients had a history of rheumatoid arthritis,1 had a history of pulmonary tuberculosis,1 had a history of chronic bronchitis,and the remaining 4 had been in good health.The main features of chest CT were multiple nodules or mass shadows with or without cavities in 6 patients,and large high-density shadows in 2.Three patients underwent lung biopsy mNGS,among whom 1 was diagnosed with pulmonary tuberculosis whose lung biopsy mNGS identified Mycobacterium tuberculosis complex while the CMT was negative,1 was diagnosed with pulmonary cryptococcosis whose CMT detected Cryptococcus and the lung biopsy mNGS was negative,and 1 was diagnosed with anti-neutrophil cytoplasmic antibody-associated vasculitis by histopathological examination and the lung biopsy mNGS and CMT were both negative.In 5 patients undergoing both lung biopsy and BALF mNGS,3 were diagnosed with Pneumocystis jirovecii pneumonia,pulmonary Aspergillosis,and Streptococcal pneumonia,respectively,and BALF mNGS identified Pneumocystis jirovecii,Aspergillus niger+Aspergillus oryzae and Streptococcus respectively,but their lung biopsy mNGS and CMT results were negative,among whom 1 patient was confirmed Aspergillus niger twice by BALF mNGS;1 was diagnosed with pulmonary tuberculosis whose lung biopsy and BALF mNGS results were negative,and the CMT identified Mycobacterium tuberculosis;1 was diagnosed with pulmonary fungal infection whose BALF mNGS and CMT results were negative,and the lung biopsy mNGS confirmed Rhodotorula mucilaginosa.The detection rate of BALF mNGS in 5 patients was 66.7％and the detection rate of lung biopsy mNGS was 20.0％.In 7 patients with pulmonary infection(pulmonary tuberculosis in 2,pulmonary fungal infection in 4,Streptococcus pneumonia in 1),the detection rates of pathogenic microorganisms by lung biopsy mNGS,BALF mNGS and CMT were 28.6％,66.7％and 28.6％,respectively.One patient with pulmonary tuberculosis was lost to follow-up,1 patient with anti-neutrophil cytoplasmic antibody-associated vasculitis was aggravated due to irregular medication,and the remaining patients got improved after anti-infection treatment according to etiologic results.Conclusions For pulmonary infection with unconfirmed CMT diagnosis,CT-guided percutaneous lung biopsy mNGS and BALF mNGS can be the supplement methods to CMT,especially in the diagnosis of rare pulmonary fungal infection.BALF mNGS has a higher detection rate of pathogenic microorganisms than lung biopsy mNGS,and BALF can be as a preferred specimen for mNGS.
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