Thirteen datasets across 12 publications met the inclusion criteria (909 participants, range 30 to 116). Four studies were retrospective case-control studies. Eight studies recruited consecutive patients. Four studies were retrospective and four prospective cohort studies. More than 60% of studies were subject to progression bias, did not blind interpreters of the index test and/or reference standard and did not report uninterpretable results. Differential and verification biases and incorporation bias were avoided in approximately 60% to 70% of studies. Approximately 50% of studies had a representative patient spectrum. STARD scores ranged from 12 to 18 (maximum score attainable was not reported).
Across the 13 datasets, sensitivity ranged from 59% to 100% and specificity from 76% to 100%. Pooled sensitivity was 90% (95% CI, 79% to 96%), specificity was 94% (95% CI, 90% to 96%), positive likelihood ratio was 14.87 (95% CI 8.89 to 24.90), and negative likelihood ratio was 0.10 (95% CI 0.04 to 0.24). With a disease prevalence of 12%, the post-test probability of proven or probable invasive aspergillosis was 67% with a positive test and 1% with a negative test. When only proven cases were considered positive on the reference standard (10 studies), pooled sensitivity was 94% (95% CI, 86% to 98%), specificity was 79% (95% CI, 68% to 86%), positive likelihood ratio was 4.41 (95% CI 2.87 to 6.77), and negative likelihood ratio was 0.07 (95% CI 0.03 to 0.19). Ι² was more than 50% for each analysis.
Results for subgroup analyses and different cut-off values for the bronchoalveolar lavage galactomannan assay were presented. Sensitivity and specificity were lowered when patients were receiving antifungal treatment. There was no evidence of publication bias.