Abstract / Summary
Purpose: Invasive fungal disease (IFD) remains a major cause of morbidity and mortality in patients with hematologic malignancies. The European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) definitions are widely used in research settings; however, their application in routine clinical practice is often constrained by limited availability of invasive diagnostic procedures and mycologic confirmation.Materials and methods: This single-center retrospective cohort study included adult hematologic malignancy patients evaluated for suspected invasive pulmonary fungal infection at Pamukkale University Hospital (Jan 2024-Dec 2025). Patients were categorized per EORTC/MSGERC 2020 as Proven, Probable, Possible, or No IFD. Demographic, clinical, radiologic, and mycologic data including serum and bronchoalveolar lavage (BAL) galactomannan were collected. Analyses focused on EORTC/MSGERC diagnostic categories and real-world diagnostic testing patterns.Results: A total of 91 patients were included (mean age 63.2±12.3 years; 50.5% male). According to EORTC/ MSGERC 2020 criteria, 22 patients (24.2%) were classified as Probable IFD, 52 (57.1%) as Possible IFD, and 17 (18.7%) as No IFD; no cases met the criteria for Proven IFD due to the absence of sterile-site mycologic or histopathologic confirmation. Radiologic findings compatible with IFD were present in 74 patients (81.3%). Serum galactomannan testing was available in 78 patients (85.7%), whereas BAL galactomannan testing was performed in only 18 patients (19.8%). Overall in-hospital mortality was 48.4%.Conclusions: In this cohort, EORTC/MSGERC 2020 criteria application was hindered by difficulties in invasive sampling. The lack of Proven IFD and predominance of Possible IFD highlight gaps between research definitions and clinical practice, emphasizing the need for practical diagnostic strategies integrating clinical, radiologic, and non-invasive mycologic markers in high-risk hematology patients.