Diagnostic value of bronchoalveolar lavage fluid testing combined with high-resolution computed tomography of patients with invasive pulmonary fungal disease

This study was aimed to evaluate the diagnostic value of bronchoalveolar lavage fluid (BALF) testing plus high-resolution computed tomography (HRCT) of patients with invasive pulmonary fungal infection (IPFI). Two hundred and thirty patients with invasive pulmonary fungal disease were rolled into invasive group (n = 104) and non-invasive group (n = 126) under the diagnostic criteria for IPFI. All patients underwent BALF testing and HRCT imaging. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of BALF testing, HRCT imaging, and their combination were calculated. Seven fungal species were identified in invasive group, with Aspergillus fumigatus exhibiting the highest isolation rate of 61 cases (58.65 %). BALF testing detected fungi in 87 patients, including 57 cases of Aspergillus fumigatus , demonstrating a concordance rate of 93.44 %. The prevalence of IPFI was 45.22 % (104/230). HRCT findings revealed that invasive fungal infections predominantly affected the left upper lobe (51 cases, 25.89 %). Radiological features included cavities (36.54 %), solitary nodules or masses (25.96 %), aspergillomas (16.35 %), and patchy or consolidative opacities (21.15 %). 1,3-β-D-glucan in serum and galactomannan (GM) in BALF in the invasive group was relatively higher than non-invasive group ( P < 0.05). BALF testing demonstrated a sensitivity of 73.08 %, specificity of 91.27 %, PPV of 87.36 %, NPV of 80.42 %, and an area under the ROC curve (AUC) of 0.591. HRCT imaging showed a sensitivity of 65.38 %, specificity of 92.06 %, PPV of 87.18 %, NPV of 76.32 %, and an AUC of 0.724. Combined testing (BALF + HRCT) exhibited superior performance, achieving a sensitivity of 84.62 %, specificity of 93.65 %, PPV of 91.67 %, NPV of 88.06 %, and an AUC of 0.807. The combination of BALF testing and chest HRCT demonstrates high diagnostic value for IPFI, greatly improving sensitivity and specificity. This integrated approach shows promising diagnostic value and may provide a useful basis for clinical decision-making, though findings require validation in larger, prospective, multi-center studies.