Clinical utility and prognostic value of bronchoalveolar lavage galactomannan in patients with hematologic malignancies.
We conducted a single-center retrospective cohort study to determine the performance characteristics of the galactomannan (GM) assay in bronchoalveolar lavage (BAL) in patients with hematologic malignancies. Patients were classified as proven, probable, possible, or no invasive pulmonary aspergillosis (IPA), according to international guidelines. A total of 173 BAL samples from 145 patients were included. There were 5 proven, 7 probable, and 35 possible cases of IPA. Using a GM index cutoff of ≥ 0.5, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of the BAL GM assay were 100%, 78%, 26%, and 100%, respectively. Using a GM index cutoff of ≥ 2.0, the sensitivity and NPV remained 100%, but specificity and PPV increased to 93% and 50%, respectively. The BAL GM assay is a highly sensitive screening test for IPA in patients with hematologic malignancies. Increasing the cutoff value to 2.0 would improve the performance of this assay.
Luong
Me-Linh
ML
Department of Microbiology, McGill University Health Center, Montreal, Quebec, Canada.
Filion
Charles
C
Labbé
Annie-Claude
AC
Roy
Jean
J
Pépin
Jacques
J
Cadrin-Tourigny
Julia
J
Carignan
Stéphane
S
Sheppard
Donald C
DC
Laverdière
Michel
M
D000946:Antigens, Fungal / Q000032:analysis; D001230:Aspergillus / Q000276:immunology / Q000302:isolation & purification*; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D001999:Bronchoscopy; D002170:Canada; D015331:Cohort Studies; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007124:Immunoenzyme Techniques; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008351:Mannans / Q000032:analysis* / Q000276:immunology; D008875:Middle Aged; D016533:Mycological Typing Techniques; D009894:Opportunistic Infections / Q000175:diagnosis / Q000382:microbiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D000946:Antigens, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose