title: Galactomannan detection in bronchoalveolar lavage fluid for the diagnosis of invasive aspergillosis in patients with hematological diseases-the role of factors affecting assay performance.
abstract: BACKGROUND
  We evaluated the performance of a galactomannan (GM) assay in bronchoalveolar lavage (BAL) fluid compared to serum samples for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with hematological diseases.
  
  
  METHODS
  Two hundred and fifty-five bronchoscopies were performed on 230 patients. Bronchial and alveolar samples from BAL fluid as well as serum samples were analyzed in the GM assay.
  
  
  RESULTS
  Twenty-eight cases of IPA (11%) were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value of the GM assay using a cut-off of 0.5 were 57.1%, 99.3%, 94.1%, and 92.5%, respectively, for the alveolar sample; 44.0%, 99.3%, 91.7%, and 91.4%, respectively, for the bronchial sample; and 60.7%, 100%, 100%, and 92.9%, respectively, for serum. The highest sensitivity (78.6%) with good specificity (98.6%) was obtained with a 'triple detection' of GM in bronchial, alveolar, and serum samples. Neutropenia and antifungal therapy for only 24h increased the sensitivity, while antifungal treatment for ≥ 2 days decreased assay performance. Moreover, a trend towards a higher volume of aspirated fluid in GM-negative BAL (p=0.092) was observed.
  
  
  CONCLUSIONS
  In contrast to recently published data, we found only moderate sensitivity, but high specificity and high positive predictive value of the detection of GM in BAL fluid. In addition, neutropenia, antifungal therapy, and BAL standardization affected GM assay performance.
authors: Department of Internal Medicine - Hematology and Oncology, Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic. zracil@fnbrno.cz
authors: Zdenek
authors: Z
authors: Racil
authors: Iva
authors: I
authors: Kocmanova
authors: Martina
authors: M
authors: Toskova
authors: Lucie
authors: L
authors: Buresova
authors: Barbora
authors: B
authors: Weinbergerova
authors: Martina
authors: M
authors: Lengerova
authors: Monika
authors: M
authors: Rolencova
authors: Jana
authors: J
authors: Winterova
authors: Kristyna
authors: K
authors: Hrncirova
authors: Pavlina
authors: P
authors: Volfova
authors: Jana
authors: J
authors: Skrickova
authors: Jiri
authors: J
authors: Mayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D001230:Aspergillus / Q000737:chemistry / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D001999:Bronchoscopy; D015331:Cohort Studies; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D006402:Hematologic Diseases / Q000150:complications*; D019337:Hematologic Neoplasms / Q000150:complications; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008351:Mannans / Q000032:analysis* / Q000097:blood; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose