Diagnostic Performance and Safety of Bronchoalveolar Lavage in Thrombocytopenic Haematological Patients for Aspergillosis Diagnosis: A Monocentric, Retrospective Experience.

Abstract

BackgroundAlthough bronchoalveolar lavage (BAL) measurements of galactomannan antigen (GM) seems to be more sensitive than serum testing to detect invasive fungal infection (IFI), a consensus on the most appropriate diagnostic threshold of the BAL GM test is still unclear. Moreover, there is uncertainty as to whether BAL is a safe procedure in patients with hematological malignancies (HM) and thrombocytopenia.ObjectivesBased on this background, 102 adult patients with HM and associated thrombocytopenia were retrospectively analyzed with the dual aim of 1) determining whether BAL is a safe and feasible procedure; and, 2) identifying the most appropriate threshold for GM positivity in the diagnosis of IFI.Patients/Methodseach BAL was considered as one case/patient. One hundred twelve BALs were carried out in 102 HM patients: at the time of the BAL, the median platelet count (PLTs) in all patients was 47×109/L (1–476), and 31 patients (27%) had PLTs< 20×109/L.Resultscomplications from the BAL were infrequent (3.5%) and mild. No bleeding was reported. The BAL GM cut off of >0.8 was associated with the best diagnostic accuracy (sensitivity 72.97% and specificity 80%). Antifungal treatment of patients with BAL GM >0.8 resulted in a clinical-radiological improvement in 35/41 patients (85%).ConclusionsBAL was a safe procedure also in thrombocytopenic patients, permitting an IFI diagnosis not otherwise identifiable using EORTC/MSG criteria. Our data suggest that a BAL GM value of>0.8 represents the most useful cut-off in terms of sensibility and specificity. Further prospective studies on a more significant number of patients are needed to confirm these results.

Invasive aspergillosis in relapsed/refractory acute myeloid leukaemia patients: Results from SEIFEM 2016‐B survey

“…First, the current diagnostic approach is prompter and more aggressive than in the past. In the last years, bronchoscopy has been shown to be a safe procedure in patients with AML, who are often thrombocytopenic 17,18 . The early bronchoscopy and galactomannan test in bronchoalveolar lavage fluid together with dosage of serum galactomannan may increase the effectiveness of IA treatment 17 .…”

“…In the last years, bronchoscopy has been shown to be a safe procedure in patients with AML, who are often thrombocytopenic. 17,18 The early bronchoscopy and galactomannan test in bronchoalveolar lavage fluid together with dosage of serum galactomannan may increase the effectiveness of IA treatment. 17 Furthermore, in our study, most of IA were breakthrough infections.…”

Galactomannan and 1, 3-β-D-Glucan Assay in Bronchoalveolar Lavage Fluid for the Diagnosis of Invasive Pulmonary Aspergillosis in Malignant and Non-malignant Patients

“…Overall moderate sensitivity was recorded for galactomannan when used as a single biomarker [9]. Although galactomannan had repeatedly shown high specificity in BAL fluid, its performance as a single test was not fully satisfactory; besides its optimum cutoff was not agreed upon [12]. Some molds do not produce either galactomannan or BDG (e.g., Mucor and Rhizopus) and this means that a negative test does not rule out invasive fungal infection [13].…”

Clinical Usefulness of Brochoalveolar Lavage in the Management of Pulmonary Infiltrates in Adults With Haematological Malignancies and Stem Cell Transplantation

“…These numbers are lower than those reported in the literature. 12,17,36 Non-invasive diagnostic methods led to 30 positive microbiological results, mainly respiratory viruspositive swabs or sputum culture. However, BAL was performed in 9 of these cases, mainly due to the high possibility of co-infections in this group of patients.…”