Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston Salem, NC.
Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest Baptist Medical Center, Winston Salem, NC.
Int Forum Allergy Rhinol. 2019 Jan;9(1):60-66. doi: 10.1002/alr.22225. Epub 2018 Oct 25.
Pathologic diagnosis remains the gold standard for final diagnosis of acute invasive fungal sinusitis (AIFS); however, other less invasive tests could suggest the presence of AIFS in at-risk populations where early diagnosis is crucial. Serum galactomannan Aspergillus antigen has been shown to correlate with a diagnosis of invasive pulmonary aspergillosis; however, it has not adequately been evaluated in regard to AIFS. The objective of this study is to evaluate the statistical relevance of galactomannan in predicting diagnosis of AIFS.
This study was a retrospective review of pathologic records using Co-Path from 2006 to 2017, incorporating 2 separate searches with designated criteria identifying patients who received pathologic evaluation for invasive fungal sinusitis. Electronic medical records were subsequently reviewed. After exclusions isolating at-risk populations and removing duplications, 78 cases were reviewed using the indicated search criteria. Of these, 38 met further criteria of having had both pathologic evaluation and galactomannan analysis. Statistical variables were assessed, as well as all-cause mortality. Peak and closest galactomannan levels were evaluated.
Overall, galactomannan had a sensitivity of 44.8% (95% confidence interval [CI], 26.5% to 64.3%), specificity of 100% (95% CI, 66.4% to 100%), positive predictive value of 100% (95% CI, 74.3% to 100%), and negative predictive value of 36% (95% CI, 18.0% to 57.5%). No significant association was observed in galactomannan status and mortality in this patient population.
Positive serum galactomannan can be an indication of AIFS in patients with a high clinical suspicion. In our study, a positive galactomannan always correlated with a positive pathologic diagnosis. However, given its low sensitivity, one must use caution in relying on galactomannan as a screening tool in diagnosis of AIFS.
病理诊断仍然是急性侵袭性真菌性鼻窦炎（AIFS）的金标准；然而，在需要早期诊断的高危人群中，其他侵袭性较小的检查可以提示 AIFS 的存在。血清半乳甘露聚糖曲霉抗原已被证明与侵袭性肺曲霉病的诊断相关；然而，它在 AIFS 方面的评估还不够充分。本研究的目的是评估半乳甘露聚糖在预测 AIFS 诊断中的统计学相关性。
本研究是对 2006 年至 2017 年期间使用 Co-Path 的病理记录进行的回顾性研究，采用了 2 项独立的搜索，指定了识别接受侵袭性真菌性鼻窦炎病理评估的患者的标准。随后对电子病历进行了审查。在排除孤立的高危人群和消除重复项后，使用指示的搜索标准对 78 例病例进行了回顾。其中，38 例进一步符合有病理评估和半乳甘露聚糖分析的标准。评估了统计学变量以及全因死亡率。评估了半乳甘露聚糖的峰值和最近水平。
总体而言，半乳甘露聚糖的敏感性为 44.8%（95%置信区间[CI]，26.5%至 64.3%），特异性为 100%（95%CI，66.4%至 100%），阳性预测值为 100%（95%CI，74.3%至 100%），阴性预测值为 36%（95%CI，18.0%至 57.5%）。在该患者人群中，未观察到半乳甘露聚糖状态与死亡率之间存在显著关联。
血清半乳甘露聚糖阳性可提示高临床怀疑度的 AIFS 患者。在我们的研究中，阳性半乳甘露聚糖总是与阳性病理诊断相关。然而，鉴于其低敏感性，在诊断 AIFS 时必须谨慎使用半乳甘露聚糖作为筛查工具。
