DIAGNOSTIC PERFORMANCE AND SAFETY OF BRONCHOALVEOLAR LAVAGE IN THROMBOCYTOPENIC HAEMATOLOGICAL PATIENTS FOR ASPERGILLOSIS DIAGNOSIS: A MONOCENTRIC, RETROSPECTIVE EXPERIENCE.

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Mariagiovanna Cefalo *
Ermanno Puxeddu
Loredana Sarmati
giovangiacinto paterno
Carla Fontana
Daniela Nassa
Gloria Pane
Eleonora De Bellis
Raffaele Palmieri
Elisa Buzzatti
Federico Meconi
Roberta Laureana
Paola Casciani
Anna Giulia Zizzari
Paola Rogliani
Paolo de Fabritiis
Luca Maurillo
Francesco Buccisano
Maria Cantonetti
William Arcese
Adriano Venditti
Maria Ilaria Del Principe
(*) Corresponding Author:
Mariagiovanna Cefalo | mariagiovanna.cefalo@hotmail.it

Abstract

Background: although bronchoalveolar lavage (BAL) measurements of galactomannan antigen (GM) seems to be more sensitive than serum testing to detect invasive pulmonary aspergillosis (IPA), 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 (TC).


Objectives: based on this background, 102 adult patients with HM and associated thrombocytopenia were retrospectively analyzed with the twin aims 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 IPA.


Patients/Methods: each 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 platelets count (PLTs) in all patients was 47x109/L (1-476) and 31 patients (27%) had PLTs< 20x109/L.


Results: complications 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 >0.8resulted in  a clinical-radiological improvement in 35/41patients (85%).


Conclusions: BAL was a safe procedure also in thrombocytopenic patients, permitting an IPA 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 larger number of patients are needed to confirm these results.


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