Effect of volume of instillate on the diagnostic utility of bronchoalveolar lavage galactomannan in patients with suspected chronic pulmonary aspergillosis—A pilot study

Background Bronchoalveolar lavage (BAL) galactomannan (GM) is commonly used to diagnose Aspergillus‐related lung diseases. However, unlike serum GM, which is measured in undiluted blood, BAL‐GM is estimated using variable aliquots and cumulative volume of instillates during bronchoscopy. Objective S...

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Bibliographic Details
Published in:Mycoses 2024-01, Vol.67 (1), p.e13695-n/a
Main Authors: Ajayababu, Anuj, Singh, Gagandeep, Meena, Ved Prakash, Upadhyay, Ashish Datt, Rana, Bhaskar, Sethi, Prayas, Prakash, Bindu, Singh, Amandeep, Vyas, Surabhi, Sinha, Sanjeev, Xess, Immaculata, Wig, Naveet, Kabra, Sushil Kumar, Ray, Animesh
Format: Article
Language:English
Subjects:
Alveoli
Aspergillosis
biomarker
Bronchoalveolar Lavage
Bronchoalveolar Lavage Fluid - microbiology
bronchoalveolar lavage galactomannan
Bronchoscopy
Bronchus
Classification
diagnostic accuracy
Discordance
Enzyme immunoassay
Galactose - analogs & derivatives
Humans
instillate volume
Invasive Pulmonary Aspergillosis - diagnosis
Invasive Pulmonary Aspergillosis - microbiology
Lavage
Lung diseases
Mannans
Persistent Infection
Pilot Projects
Population studies
pulmonary aspergillosis
Pulmonary Aspergillosis - diagnosis
Sensitivity and Specificity
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Summary:Background Bronchoalveolar lavage (BAL) galactomannan (GM) is commonly used to diagnose Aspergillus‐related lung diseases. However, unlike serum GM, which is measured in undiluted blood, BAL‐GM is estimated using variable aliquots and cumulative volume of instillates during bronchoscopy. Objective Since different studies have reported varying diagnostic accuracy and cut‐offs for BAL‐GM in CPA, we hypothesized that the total volume of instillate and ‘order/label’ of aliquots significantly affects the BAL‐GM values, which was evaluated as part of this study. Patients & Methods We obtained 250 BAL samples from 50 patients (five from each) with suspected chronic pulmonary aspergillosis. BAL fluid was collected after instilling sequential volumes of 40 mL of normal saline each for the first four labels and a fifth label was prepared by mixing 1 mL from each of the previous labels. The GM level of each label was measured by PLATELIA™ ASPERGILLUS Ag enzyme immunoassay. This study measured the discordance, level of agreement, diagnostic characteristics (sensitivity, specificity and AUROC) and best cut‐offs for BAL‐GM in the different aliquots of lavage fluid. Results The study population, classified into CPA (28%) and non‐CPA (72%) groups, based on ERS/ESCMID criteria (excluding BAL‐GM) were not different with respect to clinico‐radiological characteristics. The discordance of BAL‐GM positivity (using a cut‐off of >1) between the serial labels for the same patient ranged between 10% and 22%, while the discordance between classification using BAL‐GM positivity (using a cut‐off of ≥1) and clinic‐radio‐microbiological classification ranged between 18% and 30%. The level of agreement for serial labels was at best fair (
ISSN:0933-7407
1439-0507
DOI:10.1111/myc.13695