Diagnostic value of bronchoalveolar lavage fluid galactomannan assay for invasive pulmonary aspergillosis in adults: A meta‐analysis

Abstract

What is known and objective: To analyse the diagnostic accuracy of bronchoalveolar lavage fluid galactomannan (BALF-GM) assay for invasive pulmonary aspergillosis (IPA) in adults to determine the optimal diagnostic cut-off by meta-analysis.Methods: PubMed, Embase, Web of Science, Cochrane Library, China national knowledge infrastructure (CNKI), and China Wanfang databases were searched to collect relevant studies on the diagnostic value of BALF-GM for IPA from inception to March 2022. The summary receiver operating characteristic (SROC) curve was drawn to determine the optimal diagnostic cut-off.Results and discussion: Nineteen articles (56 data sets) were included. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were 0.79 (95% CI: 0.72-0.84), 0.92 (95% CI: 0.88-0.94), 9.25 (95% CI: 6.84-12.52), 0.23 (95% CI: 0.18-0.30), 39.44 (95% CI: 29.55-52.65), and 0.92 (95% CI: 0.90-0.94), respectively. The area under the curves (AUCs) were 0.92, 0.86, 0.93, 0.89, 0.88, and 0.94 when the cut-off values were 0.5, 0.8, 1.0, 1.5, 2.0, and 3.0, respectively. Sixteen studies were included in the combined analysis when the cut-off value was 0.5. The results showed that the pooled sensitivity, specificity, PLR, NLR and DOR of BALF-GM (cut-off 0.5) for the diagnosis of IPA were 0.89 (95%

Invasive Pulmonary Aspergillosis

“…The cut-off for positivity in serum is still controversial: single value over 0.5 is recommended by the manufacturer, while experts suggest a cut-off over 0.7 for a single test or two consecutive tests > 0.5 [ 119 ]. In BALF too, there is no consensus between >0.5 and >1.0, although a recent meta-analysis including 19 articles concluded in favor of the >0.5 cut-off associated with a sensitivity of 89% and a specificity of 79% [ 120 ].…”

A nomogram model in invasive pulmonary aspergillosis diagnosis based on a retrospective study

“…Only 37.3% (19/51) of the serum GM tests were positive in patients diagnosed with IPA in this study. Moreover, 46.8% (15/32) of those who received antifungal treatment before GM test .The results of our study demonstrated that BALF is the optimal specimen for Aspergillus culture and GM test [14] . But there was no significant difference in the levels of anti-Aspergillus antibodies between the two groups.…”

“…The classical imaging features of IPA embrace air crescent, halo, cavitation, and nodule. However, a study of 72 proven cases of IPA found that non-vascular invasion signs, such as nonspecific infiltrates and consolidation, were more commonly observed (68.1% and 38.9% respectively) than typical signs [13] .The delay in diagnosis IPA lead to treatment delays, thus increasing the morbidity and mortality of IPA, which is more common in patients with nonimmunosuppressive diseases [14] .…”

Diagnostic accuracy of galactomannan and lateral flow assay in invasive aspergillosis: A diagnostic meta-analysis

“…In addition, BALF ODI 1.0 pooling resulted in a sensitivity of 0.75 and a specificity of 0.96 [ 44 ]. Moreover, in another meta-analysis, it was shown that the AUCs were 0.92, 0.86, 0.93, 0.89, 0.88, and 0.94 when the cut-off values were 0.5, 0.8, 1.0, 1.5, 2.0, and 3.0, respectively [ 48 ]. For the other factors, differences in diagnostic levels of the different variables were explored by regression in the heterogeneity assessment, where neutropenia and consecutive sampling significantly affected the sensitivity of the diagnosis.…”