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

Abstract

Background: 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.