{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T04:13:42Z","timestamp":1754108022137,"version":"3.41.2"},"reference-count":29,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,1,21]],"date-time":"2024-01-21T00:00:00Z","timestamp":1705795200000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Bronchoalveolar lavage (BAL) galactomannan (GM) is commonly used to diagnose <jats:italic>Aspergillus<\/jats:italic>\u2010related lung diseases. However, unlike serum GM, which is measured in undiluted blood, BAL\u2010GM is estimated using variable aliquots and cumulative volume of instillates during bronchoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>Since different studies have reported varying diagnostic accuracy and cut\u2010offs for BAL\u2010GM in CPA, we hypothesized that the total volume of instillate and \u2018order\/label\u2019 of aliquots significantly affects the BAL\u2010GM values, which was evaluated as part of this study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients &amp; Methods<\/jats:title><jats:p>We obtained 250 BAL samples from 50 patients (five from each) with suspected chronic pulmonary aspergillosis. BAL fluid was collected after instilling sequential volumes of 40\u2009mL of normal saline each for the first four labels and a fifth label was prepared by mixing 1\u2009mL from each of the previous labels. The GM level of each label was measured by PLATELIA\u2122 ASPERGILLUS Ag enzyme immunoassay. This study measured the discordance, level of agreement, diagnostic characteristics (sensitivity, specificity and AUROC) and best cut\u2010offs for BAL\u2010GM in the different aliquots of lavage fluid.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study population, classified into CPA (28%) and non\u2010CPA (72%) groups, based on ERS\/ESCMID criteria (excluding BAL\u2010GM) were not different with respect to clinico\u2010radiological characteristics. The discordance of BAL\u2010GM positivity (using a cut\u2010off of &gt;1) between the serial labels for the same patient ranged between 10% and 22%, while the discordance between classification using BAL\u2010GM positivity (using a cut\u2010off of \u22651) and clinic\u2010radio\u2010microbiological classification ranged between 18% and 30%. The level of agreement for serial labels was at best fair (&lt;0.6 for all except one \u2018label\u2019). The AUROC for the serial samples ranged between 0.595 and 0.702, with the \u201840\u2009mL and the \u2018mix\u2019 samples performing the best. The best BAL\u2010GM cut\u2010off also showed significant variation between serial labels of varying dilutions (Range:1.01 \u2010 4.26).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>This study highlights the variation in BAL\u2010GM measured and the \u2018positivity\u2019 between different \u2018labels\u2019 of aliquots of BAL, with the first aliquot and the mixed sample showing the best performances for diagnosis of CPA. Future studies should attempt to \u2018standardise\u2019 the instilled volume for BAL\u2010GM estimation to standardise the diagnostic yield.<\/jats:p><\/jats:sec>","DOI":"10.1111\/myc.13695","type":"journal-article","created":{"date-parts":[[2024,1,22]],"date-time":"2024-01-22T06:31:06Z","timestamp":1705905066000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of volume of instillate on the diagnostic utility of bronchoalveolar lavage galactomannan in patients with suspected chronic pulmonary aspergillosis\u2014A pilot study"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7909-3259","authenticated-orcid":false,"given":"Anuj","family":"Ajayababu","sequence":"first","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gagandeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Microbiology AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ved Prakash","family":"Meena","sequence":"additional","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashish Datt","family":"Upadhyay","sequence":"additional","affiliation":[{"name":"Clinical Research Unit AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhaskar","family":"Rana","sequence":"additional","affiliation":[{"name":"Department of Microbiology AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prayas","family":"Sethi","sequence":"additional","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bindu","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amandeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surabhi","family":"Vyas","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjeev","family":"Sinha","sequence":"additional","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Immaculata","family":"Xess","sequence":"additional","affiliation":[{"name":"Department of Microbiology AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naveet","family":"Wig","sequence":"additional","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sushil Kumar","family":"Kabra","sequence":"additional","affiliation":[{"name":"Department of Pediatrics AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Animesh","family":"Ray","sequence":"additional","affiliation":[{"name":"Department of Medicine AIIMS  New Delhi India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,1,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12152"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00583-2015"},{"issue":"12","key":"e_1_2_9_4_1","first-page":"ofac603","article-title":"Burden of serious fungal infections in India. 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