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Mycoses. 2019 Mar;62(3):204-213. doi: 10.1111/myc.12867. Epub 2018 Nov 25.

False positive bronchoalveolar lavage galactomannan: Effect of host and cut-off value.

Author information

1
Division of Infectious Diseases, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
2
Department of Internal Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
3
Brigham and Women's Hospital, Rhode Island Hospital, Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts.

Abstract

OBJECTIVES:

Bronchoalveolar lavage galactomannan (BAL-GM) is a mycological criterion for diagnosis of probable invasive aspergillosis (IA) per European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORT-MSG) consensus criteria, but its real-world positive predictive value (PPV) has not been well-studied. Our aim was to estimate the PPV of BAL-GM in a contemporary cohort of patients with positive BAL-GM.

METHODS:

We identified consecutive patients with ≥1 positive BAL-GM value (index ≥ 0.5) at Brigham and Women's Hospital from 11/2009 to 3/2016. We classified patients as having no, possible, probable, or proven IA, excluding BAL-GM as mycological criterion.

RESULTS:

We studied 134 patients: 54% had hematologic malignancy (HM), and 10% were solid organ transplant (SOT) recipients. A total of 42% of positive (≥0.5) BAL-GM results were falsely positive (PPV 58%). The number of probable IA cases was increased by 23% using positive BAL-GM as mycologic criterion alone. PPV was higher in patients with HM or SOT (P < 0.001) and with use of higher thresholds for positivity (BAL-GM ≥ 1 vs 1-0.8 vs 0.8-0.5: P = 0.002).

CONCLUSIONS:

42% of positive BAL-GM values were falsely positive. We propose a critical reassessment of BAL-GM cutoff values in different patient populations. Accurate noninvasive tests for diagnosis of IA are urgently needed.

KEYWORDS:

Aspergillus ; aspergillosis; galactomannan; haematologic malignancy; hematopoietic stem-cell transplantation; leukaemia; mould; transplantation

PMID:
30387195
DOI:
10.1111/myc.12867
[Indexed for MEDLINE]

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