The Value of Fiberoptic Bronchoscopy in Culture-Positive Pulmonary Tuberculosis Patients Whose Pre-Bronchoscopic Sputum Specimens were Negative both for Smear and PCR Analyses

Atsuhisa Tamura; Masahiro Shimada; Yoshinori Matsui; Masahiro Kawashima; Junko Suzuki; Haruyuki Ariga; Nobuharu Ohshima; Kimihiko Masuda; Hirotoshi Matsui; Hideaki Nagai; Naohiro Nagayama; Emiko Toyota; Shinobu Akagawa; Akira Hebisawa

doi:10.2169/internalmedicine.49.2686

ORIGINAL ARTICLES

The Value of Fiberoptic Bronchoscopy in Culture-Positive Pulmonary Tuberculosis Patients Whose Pre-Bronchoscopic Sputum Specimens were Negative both for Smear and PCR Analyses

Atsuhisa Tamura, Masahiro Shimada, Yoshinori Matsui, Masahiro Kawashima, Junko Suzuki, Haruyuki Ariga, Nobuharu Ohshima, Kimihiko Masuda, Hirotoshi Matsui, Hideaki Nagai, Naohiro Nagayama, Emiko Toyota, Shinobu Akagawa, Akira Hebisawa

Author information

Atsuhisa Tamura
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Masahiro Shimada
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Yoshinori Matsui
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Masahiro Kawashima
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Junko Suzuki
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Haruyuki Ariga
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Nobuharu Ohshima
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Kimihiko Masuda
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Hirotoshi Matsui
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Hideaki Nagai
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Naohiro Nagayama
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Emiko Toyota
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Shinobu Akagawa
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital
Akira Hebisawa
Department of Pathology, National Hospital Organization Tokyo National Hospital

Keywords: pulmonary tuberculosis, fiberoptic bronchoscopy, radiographic findings, rapid diagnosis, definitive diagnosis, drug susceptibility

JOURNAL OPEN ACCESS

2010 Volume 49 Issue 2 Pages 95-102

DOI https://doi.org/10.2169/internalmedicine.49.2686

Details

Abstract

Objective This study assessed the diagnostic rate of pulmonary tuberculosis (PTB) using fiberoptic bronchoscopy (FBS) in patients with suspected PTB, and negative pre-bronchoscopy smear and polymerase-chain reaction (PCR) in sputum.
Patients and Methods We retrospectively reviewed 201 culture-positive PTB patients that underwent FBS because both smear and PCR results in sputum were negative. The positive rates of smear for acid fast bacilli, PCR for Mycobacterium tuberculosis, the presence of granuloma in transbronchial biopsy (TBB), and culture of M. tuberculosis were analyzed. In addition, the radiographic features, contribution of FBS to rapid and/or definitive diagnosis of PTB, and drug susceptibility results of M. tuberculosis were also reviewed.
Results There were 136 males and 102 patients under the age of 40 years; non-cavitary (156 cases) and minimal disease (119 cases) on radiographs predominated. The positive rates of FBS were: 44% (smear), 62% (PCR), 61% (TBB), and 87% (culture). These rates increased in smear and PCR examinations when taken from wider spread shadows on radiographs. The combination of the various bronchoscopy samples increased the diagnostic rate to 92% when all examinations were combined. Positive culture results depended on FBS procedures in 80 cases. Twenty-one cases showed resistance to at least one of the major anti-tuberculous agents.
Conclusion This analysis revealed high positive rates of PTB from bronchoscopy samples, providing rapid and definitive ability for PTB diagnosis, and details of drug susceptibility. Therefore, FBS is an important diagnostic procedure in patients with suspected PTB whose sputum specimens were negative both for smear and PCR analyses.

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