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Войти в исследования Infection · 2026
Clinical utility of non-induced sputum galactomannan testing for suspected invasive pulmonary aspergillosis: a real-world retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Tsai Chia-Ta, Liang Shin-Yi, Lai Chung-Hsu, Tsai Ying-Nan, Chiu Chien-Tung, Huang Chun-Kai
Аннотация
PURPOSE: Non-induced sputum galactomannan (GM) testing is increasingly used in routine evaluation of suspected invasive pulmonary aspergillosis (IPA), yet its real-world performance and the clinical implications of negative results remain incompletely characterised. We aimed to evaluate its diagnostic performance relative to bronchoscopic mycological findings and to describe the short-term evolution of GM results in routine practice.
METHODS: We retrospectively analysed adult patients who underwent non-induced sputum GM testing between 2017 and 2025. Diagnostic performance was assessed in patients with paired sputum and bronchoscopic samples obtained within 7 days using a bronchoscopy-based composite mycological reference standard (defined as bronchoscopic GM index ≥ 0.5, positive Aspergillus culture, or histopathological evidence of invasion). Longitudinal GM evolution was described in patients with initially negative sputum GM results.
RESULTS: Among 1002 patients, 73 had paired samples. Sputum GM demonstrated a sensitivity of 73.7% (95% CI 53.9-93.5%), specificity of 72.2% (95% CI 60.3-84.2%), positive predictive value of 48.3% (95% CI 30.1-66.5%), and negative predictive value of 88.6% (95% CI 79.3-98.0%) for composite bronchoscopic mycological positivity. Higher sputum GM indices were associated with increasing rates of composite bronchoscopic mycological positivity (P for trend = 0.003). Among patients with initially negative sputum GM who underwent repeat testing, early follow-up (days 8-30) showed GM signal evolution in 15.1% of retested patients, whereas subsequent serum or bronchoscopic GM positivity remained uncommon (3.8%); both proportions increased with longer observation.
CONCLUSION: In routine clinical practice, non-induced sputum GM testing demonstrates moderate diagnostic performance relative to bronchoscopic mycological findings. Negative results were associated with low short-term rates of subsequent bronchoscopic or serum GM positivity. These findings may inform short-term clinical reassessment, particularly in settings where bronchoscopy is not readily available.
METHODS: We retrospectively analysed adult patients who underwent non-induced sputum GM testing between 2017 and 2025. Diagnostic performance was assessed in patients with paired sputum and bronchoscopic samples obtained within 7 days using a bronchoscopy-based composite mycological reference standard (defined as bronchoscopic GM index ≥ 0.5, positive Aspergillus culture, or histopathological evidence of invasion). Longitudinal GM evolution was described in patients with initially negative sputum GM results.
RESULTS: Among 1002 patients, 73 had paired samples. Sputum GM demonstrated a sensitivity of 73.7% (95% CI 53.9-93.5%), specificity of 72.2% (95% CI 60.3-84.2%), positive predictive value of 48.3% (95% CI 30.1-66.5%), and negative predictive value of 88.6% (95% CI 79.3-98.0%) for composite bronchoscopic mycological positivity. Higher sputum GM indices were associated with increasing rates of composite bronchoscopic mycological positivity (P for trend = 0.003). Among patients with initially negative sputum GM who underwent repeat testing, early follow-up (days 8-30) showed GM signal evolution in 15.1% of retested patients, whereas subsequent serum or bronchoscopic GM positivity remained uncommon (3.8%); both proportions increased with longer observation.
CONCLUSION: In routine clinical practice, non-induced sputum GM testing demonstrates moderate diagnostic performance relative to bronchoscopic mycological findings. Negative results were associated with low short-term rates of subsequent bronchoscopic or serum GM positivity. These findings may inform short-term clinical reassessment, particularly in settings where bronchoscopy is not readily available.