Diagnostic accuracy of metagenomic next-generation sequencing for invasive pulmonary aspergillosis: A systematic review and meta-analysis.

OBJECTIVES

To systematically evaluate the diagnostic accuracy of metagenomic next‑generation sequencing (mNGS) for invasive pulmonary aspergillosis (IPA), and to compare its sensitivity and specificity with conventional methods.

METHODS

Meta‑analysis was performed to pool sensitivity, specificity, and diagnostic odds ratio (DOR). The comparison test between mNGS and conventional diagnostic methods was conducted through pairwise comparisons, and effect size was expressed using the risk difference (RD) and 95% confidence interval.

RESULTS

Twelve studies were included, the pooled sensitivity of mNGS was 0.75 (95% CI: 0.65-0.84), specificity 0.93 (95% CI: 0.84-0.97), DOR 35.69 (95% CI: 13.70-92.97). The comparative analysis showed mNGS had higher sensitivity compared with galactomannan (RD = 0.22, 95% CI: 0.16-0.29), culture (RD = 0.40, 95% CI: 0.26-0.55), and (1→3)-β-d-glucan (BDG) (RD = 0.23, 95% CI: 0.09-0.37). For BDG assay, mNGS also demonstrated superior specificity (RD = 0.12, 95% CI: 0.04-0.20).

CONCLUSION

mNGS demonstrates promising diagnostic accuracy for IPA, with favorable sensitivity and specificity, and shows higher sensitivity than several conventional methods. BALF is the preferred specimen, and combined testing with multiple sample types improves diagnostic yield.