背景：肺部侵袭性真菌感染（pIFI）不成比例地影响血液系统恶性肿瘤（HM）患者。建立快速、准确的pFI诊断具有挑战性。多个指南建议对侵袭性真菌感染进行诊断测试，但缺乏共识，并且可能导致诊断方法不一致。
目的：确定关键诊断挑战并回顾宏基因组测序数据。
方法：PubMed，专业财团,和科学社会网站搜索以识别相关，出版,过去五年内的循证临床指南。PubMed搜索描述临床相关新型诊断技术的论文。
背景：目前对患有HM和疑似pFI的患者的指南建议胸部CT成像和带有显微镜检查的标本测试（包括calcofluor白色染色，组织病理学,细胞病理学等)，半乳甘露聚糖曲霉,β-D-葡聚糖,PCR,和文化,每个人都有一定的局限性。新兴的现实世界数据支持辅助使用基于宏基因组测序的测试来及时诊断pFI。
结论：需要来自可靠临床试验的高质量证据来确定是否应更新指南以包括新的诊断技术。试验应询问强大的新型诊断方法（如病原体不可知的宏基因组测序技术）与常规测试的结合是否可以优化影响HM患者健康的所有潜在pFI病原体的诊断产量。
BACKGROUND: Pulmonary invasive fungal infections (pIFI) disproportionately affect patients with haematological malignancies (HM). Establishing a rapid and accurate diagnosis of pIFI is challenging. Multiple
guidelines recommend diagnostic testing of invasive fungal infections but lack
consensus and may contribute to inconsistent diagnostic approaches.
OBJECTIVE: To identify key diagnostic challenges and review metagenomic sequencing data.
METHODS: PubMed, professional consortium, and scientific society websites search to identify relevant, published, evidence-based clinical
guidelines within the past 5 years. PubMed searchs for papers describing clinically relevant novel diagnostic technologies.
BACKGROUND: Current
guidelines for patients with HM and suspected pIFI recommend chest computed tomography imaging and specimen testing with microscopic examination (including calcofluor white stain, histopathology, cytopathology, etc.), Aspergillus galactomannan, β-D-glucan, PCR, and culture, each with certain limitations. Emerging real-world data support the adjunctive use of metagenomic sequencing-based tests for the timely diagnosis of pIFI.
CONCLUSIONS: High-quality evidence from robust clinical trials is needed to determine whether
guidelines should be updated to include novel diagnostic technologies. Trials should ask whether the combination of powerful novel diagnostics, such as pathogen-agnostic metagenomic sequencing technologies in conjunction with conventional testing can optimize the diagnostic yield for all potential pIFI pathogens that impact the health of patients with HM.
