Diagnostic accuracy of bronchoalveolar lavage fluid-based testing for pulmonary cryptococcosis: A systematic review and meta-analysis.

Zongsheng Tian; Xueyan Sun; Zuojuan Zhang; Qingdi Du; Xueliang Xu; Qingdi Zeng

doi:10.1016/j.diagmicrobio.2026.117612

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Diagnostic accuracy of bronchoalveolar lavage fluid-based testing for pulmonary cryptococcosis: A systematic review and meta-analysis.

Zongsheng Tian·Xueyan Sun·Zuojuan Zhang·Qingdi Du·Xueliang Xu·Qingdi Zeng

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Abstract

BACKGROUND: Pulmonary cryptococcosis(PC) presents diagnostic challenges because of its non-specific clinical and radiological manifestations. Bronchoalveolar lavage fluid (BALF)-based testing, which includes latex agglutination (LA) and lateral flow assay (LFA), offers a minimally invasive diagnostic method, yet its pooled diagnostic accuracy remains unclear. METHODS: We systematically searched PubMed, Embase, Cochrane Library, and Scopus from inception to May 2026. Studies evaluating BALF-based testing for PC with extractable 2 × 2 data were included. The methodological quality of relevant studies was assessed by the QUADAS-2 tool. Pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR) were estimated using a bivariate random-effects model. Subgroup analyses were performed by testing method and reference standard type. Heterogeneity was evaluated through paired forest plots, HSROC visualization, and exploratory bivariate meta-regression. RESULTS: The pooled sensitivity was 0.87 (95% CI: 0.81-0.91), and the specificity was 0.99 (95% CI: 0.982 - 0.995). The pooled positive likelihood ratio (PLR) was 88.00 (95% CI: 47.39 - 163.42), the negative likelihood ratio (NLR) was 0.13 (95% CI: 0.09 -0.20), and the DOR was 658.50 (95% CI: 285.36-1519.55). No significant threshold effect or publication bias was detected. Exploratory meta-regression suggested a possible assay-method effect in the joint model (P = 0.03), mainly driven by specificity (P = 0.01). CONCLUSIONS: The study demonstrates the high accuracy of CrAg in BALF for the diagnosis of pulmonary cryptococcosis, supporting its role as an important adjunctive diagnostic tool, particularly when tissue biopsy is not feasible or rapid results are needed. Larger prospective studies with standardized protocols are needed to validate these estimates.

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Humans Cryptococcosis Bronchoalveolar Lavage Fluid Sensitivity and Specificity Lung Diseases, Fungal Latex Fixation Tests Bronchoalveolar lavage fluid Diagnostic accuracy Lateral flow assay Latex agglutination Meta analysis Pulmonary cryptococcosis Journal Article Systematic Review Meta-Analysis Review

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Zongsheng Tian, Xueyan Sun, Zuojuan Zhang, Qingdi Du, Xueliang Xu, Qingdi Zeng. 2026-08-10. Diagnostic accuracy of bronchoalveolar lavage fluid-based testing for pulmonary cryptococcosis: A systematic review and meta-analysis.. https://doi.org/10.1016/j.diagmicrobio.2026.117612

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Bronchoalveolar Lavage Fluid subject Cryptococcosis subject Diagnostic accuracy subject Humans subject Journal Article subject Journal Article; Systematic Review; Meta-Analysis; Review resource Lateral flow assay subject Latex Fixation Tests subject Latex agglutination subject Lung Diseases, Fungal subject Meta analysis subject Meta-Analysis subject Systematic reviews study

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