Clinical utility and prognostic value of bronchoalveolar lavage galactomannan in patients with hematologic malignancies

Abstract 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 as...

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Bibliographic Details
Published in:Diagnostic microbiology and infectious disease 2010-10, Vol.68 (2), p.132-139
Main Authors: Luong, Me-Linh, Filion, Charles, Labbé, Annie-Claude, Roy, Jean, Pépin, Jacques, Cadrin-Tourigny, Julia, Carignan, Stéphane, Sheppard, Donald C, Laverdière, Michel
Format: Article
Language:English
Subjects:
Antigens, Fungal - analysis
Aspergillosis
Aspergillus - immunology
Aspergillus - isolation & purification
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid - chemistry
Bronchoscopy
Canada
Cohort Studies
Female
Galactomannan
Hematologic malignancies
Hematologic Neoplasms - complications
Hematopoietic Stem Cell Transplantation
Humans
Immunoenzyme Techniques
Infectious Disease
Internal Medicine
Invasive Pulmonary Aspergillosis - diagnosis
Invasive Pulmonary Aspergillosis - microbiology
Male
Mannans - analysis
Mannans - immunology
Middle Aged
Mycological Typing Techniques
Opportunistic Infections - diagnosis
Opportunistic Infections - microbiology
Predictive Value of Tests
Prognosis
Retrospective Studies
Sensitivity and Specificity
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Summary:Abstract 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.
ISSN:0732-8893
1879-0070
DOI:10.1016/j.diagmicrobio.2010.03.017