Utility of Serum and Bronchoalveolar Lavage Fluid Galactomannan in Diagnosis of Chronic Pulmonary Aspergillosis

Abstract

The value of serum and bronchoalveolar lavage fluid galactomannan (BALF-GM) in diagnosing chronic pulmonary aspergillosis (CPA) remains unclear. Here, we study the diagnostic efficacy of GM in the diagnosis of CPA. We included consecutive treatment-naive subjects with CPA. For calculating the specificity of serum GM, we enrolled diseased controls (minimally symptomatic subjects previously treated for pulmonary tuberculosis, not meeting the criteria for CPA). To calculate the specificity of BALF-GM, subjects with pulmonary disorders other than CPA who underwent bronchoscopy were included. We determined the cutoff of serum and BALF-GM levels using receiver operating characteristic (ROC) curve analysis. We enrolled 243 consecutive treatment-naive subjects (53.5% males) of CPA with a mean (standard deviation) age of 43.6 (14.7) years. Forty-five (60% males; age, 46.7 [15.7] years) and 27 (59.3% males; age, 52.6 [12.8] years) subjects served as controls for serum and BALF-GM, respectively. The best cutoff value for serum and BALF-GM was 0.55 (area under the ROC curve [AUROC], 0.605; sensitivity, 38%; specificity, 87%) and 1.375 (AUROC, 0.836; sensitivity, 68%; specificity, 93%), respectively. At a cutoff value of 2.5, BALF-GM had a sensitivity and specificity of 50% and 100%, respectively. BALF-GM performs better than serum GM and may be helpful in the diagnosis of CPA in selected patients. More studies are required to confirm our findings.

Efficiency of A fumigatus‐specific IgG and galactomannan testing in the diagnosis of simple aspergilloma

“…In the current study, BALF‐GM performed better than serum GM, like in subjects with CPA . The best diagnostic performance of BALF‐GM was at a cut‐off ODI value of 2.5.…”

“…6,[9][10][11][22][23][24][25] In a previous study, we have shown that serum and BALF-GM at a cut-off value of 0.55 and 1.4, respectively, provided the best sensitivity and specificity in diagnosing CPA. 6 The values of serum and BALF-GM for diagnosing SA were also different in this study, as CPA is minimally invasive compared to acute or subacute invasive pulmonary aspergillosis. 6 One retrospective study has evaluated the utility of serum and BALF-GM in diagnosing SA.…”

“…Serum and BALF‐GM are other frequently used investigations for diagnosing CPA . In a previous study, we have shown that serum and BALF‐GM at a cut‐off value of 0.55 and 1.4, respectively, provided the best sensitivity and specificity in diagnosing CPA .…”

“…The Institute Ethics Committee approved the study protocol, and a written informed consent was obtained from all the study participants. Some of the data have been previously published …”

“…The sensitivity and specificity for BALF-GM varied between 67%-83% and 47%-79%, respectively, using cut-offs varying from 0.5 to 1.5, based on previous studies (Table 3). 6,[9][10][11]…”