The value of fiberoptic bronchoscopy in culture-positive pulmonary tuberculosis patients whose pre-bronchoscopic sputum specimens were negative both for smear and PCR analyses.
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.


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.


CONCLUSIONS
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.
Tamura
Atsuhisa
A
Department of Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Kiyose. tamura-in@tokyo-hosp.jp
Shimada
Masahiro
M
Matsui
Yoshinori
Y
Kawashima
Masahiro
M
Suzuki
Junko
J
Ariga
Haruyuki
H
Ohshima
Nobuharu
N
Masuda
Kimihiko
K
Matsui
Hirotoshi
H
Nagai
Hideaki
H
Nagayama
Naohiro
N
Toyota
Emiko
E
Akagawa
Shinobu
S
Hebisawa
Akira
A
D000328:Adult; D000368:Aged; D001431:Bacteriological Techniques / Q000379:methods; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000254:growth & development / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction / Q000379:methods; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology* / Q000502:physiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000235:genetics / Q000382:microbiology