Proposal and Verification of New Revised Criteria for ABPA/ABPM Diagnosis

Runjin Cai,1,2,* Huan Ge,1,2,* Bin Liu,3,* Yuling Tang,4,* Jun Wang,5,* Xuemei Chen,1,2 Bing Liu,3,6 Xinyue Hu,1,2 Shuanglinzi Deng,1,2 Hui Li,4 Lixue Dai,5 Jiale Tang,1,2 Chendong Wu,1,2 Xiaoxiao Gong,1,2 Guo Wang,1,2 Xiaozhao Li,2,7 Juntao Feng1,2 1Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 2National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, People’s Republic of China; 4Department of Respiratory Medicine, the First Hospital of Changsha, Changsha, People’s Republic of China; 5The second Department of Respiratory Disease, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, People’s Republic of China; 6Wuhan Research Center for Infectious Diseases and Cancer, Chinese Academy of Medical Sciences, Wuhan, People’s Republic of China; 7Department of Nephrology, Xiangya Hospital, Central South University, Changsha, People’s Republic of China*These authors contributed equally to this workCorrespondence: Juntao Feng, Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China, Email [email protected] Xiaozhao Li, Department of Nephrology, Xiangya Hospital, Central South University, Changsha, 410008, People’s Republic of China, Email [email protected]: Although several diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) have been proposed, the disease remains frequently misdiagnosed and underdiagnosed. In 2021, Asano et al introduced new diagnostic criteria for allergic bronchopulmonary mycosis (ABPM), which were found to improve diagnostic sensitivity compared to existing criteria, but the specificity was lower.Methods: To develop revised scoring criteria for ABPA/ABPM diagnosis, delphi surveys were conducted with two rounds in 14 experts. The integer value of the mean importance scores for each item was used as the assigning values of revised scoring criteria. We evaluated the performance of existing diagnostic criteria against revised scoring criteria, using both physician diagnosis and latent class analysis (LCA) diagnosis of ABPM as reference standard.Results: We screened a total of 168 patients as initial suspected ABPM. Using physician diagnosis as the reference, diagnostic sensitivity for the Rosenberg-Patterson criteria, ISHAM criteria, revised ISHAM criteria, Asano criteria and revised scoring criteria were 39.8%, 51.6%, 64.5%, 76.3% and 86.0%, while the diagnostic specificity was 100%, 100%, 100%, 85.3% and 94.7%, respectively. When using LCA as the reference, the sensitivities of these criteria were 45.1%, 48.0%, 56.7%, 71.0%, and 76.4%, the diagnostic specificity was 100%, 100%, 98.4%, 83.8% and 95.2%, respectively.Conclusion: Revised scoring criteria showed improved diagnostic sensitivity compared to existing criteria while also enhancing specificity compared to the Asano criteria.Keywords: allergic bronchopulmonary aspergillosis, allergic bronchopulmonary mycosis, revised scoring criteria, sensitivity, specificity, latent class analysis (LCA)