Clinical data of patients with invasive pulmonary aspergillosis and non-invasive pulmonary aspergillosis.

Objective: To evaluate the diagnostic value of metagenomic next-generation sequencing (mNGS) and galactomannan (GM) test in invasive pulmonary aspergillosis (IPA) and to compare mNGS with other diagnostic approaches, including serum/ bronchoalveolar lavage fluid (BALF)-GM and conventional microbiological tests (CMTs) covering sputum smear and culture, BALF fungal culture and bronchial brushings. Materials and Methods: Totally, 271 patients were finally enrolled in this retrospective study including 154 patients with IPA (120 with mNGS testing) and 117 patients with non-IPA pulmonary infections (all with mNGS testing) treated at Henan Provincial People's Hospital from June 2021 to February 2024. The diagnostic performance of mNGS was compared with conventional diagnostic methods such as serum GM, BALF-GM, sputum smear microscopy, sputum culture, bronchial brushings, and BALF culture. Results: The proportion of patients with underlying diseases in the IPA group was significantly higher than that in the non-IPA group (P<0.05). Compared with conventional diagnostic methods for IPA, mNGS was demonstrated higher diagnostic efficacy, with a sensitivity of 92.5% and a specificity of 94.0%. The area under the receiver operating characteristic (ROC) curve for BALF-GM in diagnosing IPA was 0.8, with an optimal cutoff value of 0.5, sensitivity of 68.2%, and specificity of 82.1%. The combination of mNGS and BALF-GM testing further improved diagnostic performance, yielding a sensitivity of 96.7% and a specificity of 78.6%. Conclusion: The mNGS testing exhibits excellent diagnostic efficacy for IPA, and the combination with BALF-GM testing further enhances sensitivity. This approach has significant potential for early diagnosis and targeted treatment of IPA.