THE USE OF SURGERY IN A REAL-WORLD CLINIC TO DIAGNOSE AND TREAT PULMONARY CRYPTOCOCCOSIS IN IMMUNOCOMPETENT PATIENTS

Abstract

SESSION TITLE: Chest Infections 1 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: We evaluated the role played by surgery in the diagnosis and treatment of pulmonary cryptococcosis (PC) in immunocompetent subjects. METHODS: We retrospectively studied 53 immunocompetent patients who were pathologically diagnosed with PC between January 2000 and December 2016 in a tertiary referral center. We compared the radiological presentations of, and diagnostic modalities used to evaluate, patients diagnosed both surgically and non-surgically. We also compared the treatment outcomes of patients who underwent surgical resection alone and those who received additional antibiotics following surgical resection. RESULTS: Of the 53 patients, 30 (57%) were diagnosed via non-surgical modalities including percutaneous needle biopsy (n = 29) and transbronchial lung biopsy (n = 1); and 23 (43%) were diagnosed by surgical modalities including video-assisted thoracoscopic wedge resection (n = 22) and lobectomy (n = 1). An initial clinical suspicion of a lung malignancy was associated with the use of surgical diagnostic approaches (P < .001). Whereas undetermined locations were associated with the use of surgical diagnostic approaches, radiological findings such as clustered nodular patterns (P < .001), cavities (P = .005), air bronchograms (P < .001), and peripheral lesions (P < .001) were associated with the use of non-surgical diagnostic approaches. Of the 30 non-surgically diagnosed patients, 21 (70%) were treated with antibiotics and 9 (30%) were followed-up without treatment. Of the 23 patients who underwent surgical treatment, 8 received additional antibiotics. The proportion of patients who had clinical improvement was significantly higher in surgically diagnosed patients than non-surgically diagnosed patients (100% vs. 73%; P = .007). However, there was no significant difference in disease progression between patients who underwent surgical resection alone and those who additionally received antibiotics (P = 0.999). CONCLUSIONS: Surgical resection was required in 43% patients to diagnose PC. An initial suspicion of a lung malignancy was associated with use of surgical diagnostic approaches. Surgical resection not only afforded reliable diagnoses but also effectively treated PC. There was no need for additional antibiotics after complete surgical resection. CLINICAL IMPLICATIONS: There was no need for additional antibiotics after complete surgical resection. DISCLOSURES: No relevant relationships by Yeonseok Choi, source=Web Response no disclosure on file for Ji Yeon Kang; No relevant relationships by Hojoong Kim, source=Web Response No relevant relationships by Sunhyung Kim, source=Web Response no disclosure on file for Hyun Lee; No relevant relationships by Kyung Soo Lee, source=Web Response no disclosure on file for Sumin Shin; No relevant relationships by Bumhee Yang, source=Web Response