title: Clinical Utility of CT-Based Bronchial Aspirate TB-PCR for the Rapid Diagnosis of Pleural Tuberculosis.
abstract: BACKGROUND
  Thoracoscopic pleural biopsy is often required for rapid and confirmative diagnosis in patients with suspected pleural tuberculosis (PL-TB). However, this method is more invasive and costly than its alternatives. Therefore, we evaluated the clinical utility of the chest computed tomography (CT)-based bronchial aspirate (BA) TB-polymerase chain reaction (PCR) test in such patients.
  
  
  METHODS
  Bronchoscopic evaluation was performed in 54 patients with presumptive PL-TB through diagnostic thoracentesis but without a positive result of sputum acid-fast bacilli (AFB) smear, pleural fluid AFB smear, or pleural fluid TB-PCR test. Diagnostic yields of BA were evaluated according to the characteristics of parenchymal lesions on chest CT.
  
  
  RESULTS
  Chest radiograph and CT revealed parenchymal lesions in 25 (46%) and 40 (74%) of 54 patients, respectively. In cases with an absence of parenchymal lesions on chest CT, the bronchoscopic approach had no diagnostic benefit. BA TB-PCR test was positive in 21 out of 22 (95%) patients with early-positive results. Among BA results from 20 (37%) patients with patchy consolidative CT findings, eight (40%) were AFB smear-positive, 18 (90%) were TB-PCR-positive, and 19 (95%) were culture-positive.
  
  
  CONCLUSIONS
  The BA TB-PCR test seems to be a satisfactory diagnostic modality in patients with suspected PL-TB and patchy consolidative CT findings. For rapid and confirmative diagnosis in these patients, the bronchoscopic approach with TB-PCR may be preferable to the thoracoscopy.
authors.affiliation: Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors.forename: Jaehee
authors.initials: J
authors.lastname: Lee
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lee
authors.forename: Keum Ju
authors.initials: KJ
authors.lastname: Choi
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Lim
authors.forename: Seung Soo
authors.initials: SS
authors.lastname: Yoo
authors.forename: Shin Yup
authors.initials: SY
authors.lastname: Lee
authors.forename: Seung Ick
authors.initials: SI
authors.lastname: Cha
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Park
authors.forename: Chang Ho
authors.initials: CH
authors.lastname: Kim
keywords: Bronchoscopy; Polymerase Chain Reaction; Thoracoscopy; Tuberculosis, Pleural