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Original Research: LUNG INFECTION |

Accuracy of BAL Galactomannan in Diagnosing Invasive Aspergillosis: A Bivariate Metaanalysis and Systematic Review

Ya-Ling Guo, MD; Yi-Qiang Chen, MD, PhD; Ke Wang, MD; Shou-Ming Qin, MD; Cong Wu, MD; Jin-Liang Kong, MD, PhD
Author and Funding Information

From the Department of Respiratory Diseases (Dr Guo), Nursing School, Guangxi Medical University; and the Institute of Respiratory Diseases (Drs Chen, Wang, Qin, Wu, and Kong), First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, Republic of China.

Correspondence to: Ke Wang, MD, Institute of Respiratory Diseases, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, ROC; e-mail: walk7632@yahoo.com.cn


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml)


© 2010 American College of Chest Physicians


Chest. 2010;138(4):817-824. doi:10.1378/chest.10-0488
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Background:  A serum galactomannan (GM) assay has been approved for diagnosing invasive aspergillosis (IA). However, the role of the BAL-GM assay has not been well established. Therefore, we conducted a metaanalysis to determine the overall accuracy of BAL-GM in the diagnosis of IA.

Methods:  After a systematic review of English-language studies, the sensitivity (SEN), specificity (SPE), and positive and negative likelihood ratios (PLR and NLR, respectively) of BAL-GM for the diagnosis of IA were pooled using a bivariate metaanalysis. Hierarchic summary receiver operating characteristic curves were used to summarize overall test performance. Potential between-study heterogeneity was explored by subgroup analyses. We calculated posttest probability to evaluate clinical usefulness.

Results:  Twelve reports, including 13 studies, met our inclusion criteria. The summary estimates of the BAL-GM assay for proven or probable IA were as follows: SEN, 0.90 (95% CI, 0.79-0.96); SPE, 0.94 (95% CI, 0.90-0.96); PLR, 14.87 (95% CI, 8.89-24.90); and NLR, 0.10 (95% CI, 0.04-0.24). The four summary estimates of the BAL-GM assay for proven IA were 0.94 (95% CI, 0.86-0.98), 0.79 (95% CI, 0.68-0.86), 4.41 (95% CI, 2.87-6.77), and 0.07 (95% CI, 0.03-0.09), respectively. Significant heterogeneity was present.

Conclusions:  BAL-GM determination is a sensitive and specific test for the diagnosis of proven and probable IA. The measurement of BAL-GM is thus likely to be a useful tool for diagnosing IA. Further studies focused on the impact of treatment agents are needed.

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