Fiberoptic bronchoscopy for the rapid diagnosis of smear-negative pulmonary tuberculosis.
BACKGROUND
This study was aimed to investigate the diagnostic value of fiberoptic bronchoscopy (FOB) with chest high-resolution computed tomography (HRCT) for the rapid diagnosis of active pulmonary tuberculosis (PTB) in patients suspected of PTB but found to have a negative sputum acid-fast bacilli (AFB) smear.


METHODS
We evaluated the diagnostic accuracy of results from FOB and HRCT in 126 patients at Gangnam Severance Hospital (Seoul, Korea) who were suspected of having PTB.


RESULTS
Of 126 patients who had negative sputum AFB smears but were suspected of having PTB, 54 patients were confirmed as having active PTB. Hemoptysis was negatively correlated with active PTB. Tree-in-bud appearance on HRCT was significantly associated with active PTB. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FOB alone was 75.9%, 97.2%, 95.3%, and 84.3%, respectively, for the rapid diagnosis of active PTB. The combination of FOB and HRCT improved the sensitivity to 96.3% and the NPV to 96.2%.


CONCLUSIONS
FOB is a useful tool in the rapid diagnosis of active PTB with a high sensitivity, specificity, PPV and NPV in sputum smear-negative PTB-suspected patients. HRCT improves the sensitivity of FOB when used in combination with FOB in sputum smear-negative patients suspected of having PTB.
Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Seoul 135-720, South Korea.
Jung Ar
JA
Shin
Yoon Soo
YS
Chang
Tae Hoon
TH
Kim
Hyung Jung
HJ
Kim
Chul Min
CM
Ahn
Min Kwang
MK
Byun
D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis*