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False positive bronchoalveolar lavage galactomannan: Effect of host and cut‐off value
Author(s) -
Farmakiotis Dimitrios,
Le Audrey,
Weiss Zoe,
Ismail Nour,
Kubiak David W.,
Koo Sophia
Publication year - 2019
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.12867
Subject(s) - galactomannan , bronchoalveolar lavage , medicine , aspergillosis , gastroenterology , malignancy , immunology , lung
Summary 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.