title: Galactomannan antigen detection using bronchial wash and bronchoalveolar lavage in patients with hematologic malignancies.
abstract: BACKGROUND
  The diagnosis of invasive pulmonary aspergillosis is challenging. It is unclear whether galactomannan (GM) results from bronchial wash (BW) and bronchoalveolar lavage (BAL) samples differ in a clinically meaningful way.
  
  
  RESULTS
  Ninety-six paired (BAL and BW) samples from 85 patients were included. The average age was 53 years, 61 % of the patients were male, and 74.1 % had an underlying diagnosis of AML/MDS (ALL 7.1 %, other hematologic malignancy 18.8 %). 57 (67.1 %) patients were neutropenic, and 56 (65.9 %) patients were receiving mold-active drugs at least 48 h prior to bronchoscopy. The overall agreement between GM detection from BW and BAL was 63.5 % (K = 0.152; 95 % CI 0.008-0.311) and 73 % (K = 0.149; 95 % CI 0.048-0.348) at cut off ≥0.5 and ≥1.0, respectively. Among 43 positive samples, using a GM cut-off of 0.5, 39 (90.5 %) were positive in BW samples whereas 12 (29.3 %) were positive in BAL samples. The median level of GM in BW (0.28) samples was significantly higher than in BAL (0.20) samples among 53 samples with negative results (P = 0.001). There was no statistically significant difference in the median GM values between the BW and BAL samples with positive results (P = 0.08). There was no significant difference in GM detection between samples with positive and negative results with regard to antifungal, beta lactam antibacterial treatment or neutropenia (60.5 vs 56.6 %; 53.9 vs 46 %; 65.1 vs 54.7 %, respectively).
  
  
  CONCLUSIONS
  This retrospective study examining two collection techniques suggests that BW may have higher diagnostic yield compared to bronchoalveolar lavage for GM detection.
authors.affiliation: Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA. mtaremi@mdanderson.org.|The University of Texas MD Anderson Cancer Center, Houston, TX, USA. mtaremi@mdanderson.org.
authors.forename: Mahnaz
authors.initials: M
authors.lastname: Taremi
authors.affiliation: University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA. mkleinbe@umaryland.edu.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kleinberg
authors.affiliation: University of Maryland Medical Center, Baltimore, MD, USA. ewang@geisinger.edu.
authors.forename: Elizabeth W
authors.initials: EW
authors.lastname: Wang
authors.affiliation: Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA. Bgilliam@ihv.umaryland.edu.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Gilliam
authors.affiliation: Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, MD, USA. pryscavage@ihv.umaryland.edu.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Ryscavage
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000946:Antigens, Fungal / Q000032:analysis*; D018893:Bronchoalveolar Lavage; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis*; D008297:Male; D008351:Mannans / Q000032:analysis*; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000946:Antigens, Fungal; D008351:Mannans; C012990:galactomannan; D005690:Galactose