title: [A systematic review of the accuracy of diagnostic test of serum galactomannan antigen detection for invasive aspergillosis].
abstract: OBJECTIVE
  To assess the value of galactomannan (GM) double-direct sandwich enzyme-linked immunosorbent assay (ELISA) in the diagnosis of invasive aspergillosis (IA).
  
  
  METHODS
  A search in MEDLINE, EMbase, OVID, CBMdisc and CHKD from Jan. 1991 to Dec. 2008 was conducted to collect all articles about diagnostic tests of serum GM detection. Then the methodological quality was assessed by QUADAS-items, sources of heterogeneity investigated, pooled effect quantities evaluated, and meta-analysis studies, SROC curves, and subgroup analysis performed.
  
  
  RESULTS
  Thirty-six articles with a population of 4959 patients were included. The average prevalence of IA was 10%(532/4959). Our meta-analysis reported a median heterogeneity (I(2) = 48.6%, P < 0.05), with a pooled DOR value of 19.10 (95%CI 12.67 - 28.79), a pooled sensitivity of 0.66 (95%CI 0.61 - 0.70), a pooled specificity of 0.90 (95%CI 0.89 - 0.90), a pooled positive likelihood ratio of 5.48 (95%CI 4.27 - 7.02), a pooled negative likelihood ratio of 0.38 (95%CI 0.29 - 0.50), and an area under curve of SROC 0.88. The rate of underdiagnosis of serum GM detection was 34% (168/490) and the rate of misdiagnosis was 10% (466/4469). With a rise in the cut-off value the sensitivity of GM test decreased and specificity increased. Two consecutive positive tests decreased the sensitivity but increased the specificity. Age had no significant effect on the diagnosis by GM test. Both antifungal prophylaxis and antifungal therapy had no significant effect on sensitivity and specificity of GM test for IA diagnosis.
  
  
  CONCLUSIONS
  Serum GM detection is an effective diagnostic tool for invasive aspergillosis in high-risk populations.
authors.affiliation: Department of Respiratory Medicine, Nanjing Clinical College of the Second Military Medical University, Nanjing General Hospital of Nanjing Military Command of PLA, Nanjing 210002, China.
authors.forename: Wen-Kui
authors.initials: WK
authors.lastname: Sun
authors.forename: Feng
authors.initials: F
authors.lastname: Zhang
authors.forename: Xiao-Yong
authors.initials: XY
authors.lastname: Xu
authors.forename: Yu-Ying
authors.initials: YY
authors.lastname: Shen
authors.forename: Yi
authors.initials: Y
authors.lastname: Shi
mesh_terms: D000946:Antigens, Fungal / Q000097:blood*; D001228:Aspergillosis / Q000097:blood* / Q000175:diagnosis* / Q000276:immunology; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008351:Mannans / Q000097:blood* / Q000276:immunology; D012680:Sensitivity and Specificity
chemical_list: D000946:Antigens, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose