title: Limited value of transbronchial lung biopsy for diagnosing Mycobacterium avium complex lung disease.
abstract: OBJECTIVE
  It remains unclear whether transbronchial lung biopsy (TBLB) is useful for diagnosing Mycobacterium avium complex (MAC) lung disease.
  
  
  METHODS
  Thirty-eight consecutive patients with MAC lung disease, who were evaluated with TBLB tissue culture between June 2006 and May 2010, were included. Bronchial washing (BW) and histopathological evaluation were performed in all patients. The positivity rates of BW and TBLB tissue culture, and typical histopathological findings for MAC disease were investigated. Furthermore, all patients were divided into two groups according to the presence of intrabronchial purulent or mucopurulent secretion and the clinical, bacteriological and pathological characteristics were compared between the two groups.
  
  
  RESULTS
  The positive culture rates of BW and TBLB specimens for MAC were 100% (38 patients) and 28.9% (11 patients). BW materials were much more sensitive for culture positivity than TBLB specimens (P < 0.0001). Typical pathological findings for MAC disease were present in the TBLB specimens of only 11 patients (28.9%). Intrabronchial secretion was identified in 15 patients (39.5%, secretion-positive group) and absent in 23 patients (60.5%, secretion-negative group). Typical histopathological findings for MAC disease were more common in the secretion-positive group than in the secretion-negative group (53.3% vs 13.0%, P = 0.01), although the radiological classification and smear positivity of BW were not different between the two groups.
  
  
  CONCLUSIONS
  TBLB for pathological and bacterial investigations would provide only a limited value for MAC diagnosis. Moreover, the presence of intrabronchial secretion may be an important manifestation of ongoing airway damage, which would require early treatment.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Akimasa
authors.initials: A
authors.lastname: Sekine
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Saito
authors.affiliation: Department of Internal Medicine, Mito Medical Center, University of Tsukuba, Mito, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Satoh
authors.affiliation: Department of Pathology, National Hospital Organization, Ibarakihigashi National Hospital.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Morishita
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Tsunoda
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Yatagai
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Shih-Yuen
authors.initials: SY
authors.lastname: Lin
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Miyazaki
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Miura
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization, Ibarakihigashi National Hospital, Terunuma 825, Tokai-mura, Naga-gun, Ibaraki, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hayashihara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018893:Bronchoalveolar Lavage / Q000379:methods; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D008171:Lung Diseases / Q000175:diagnosis* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D015269:Mycobacterium avium Complex / Q000302:isolation & purification* / Q000472:pathogenicity; D015270:Mycobacterium avium-intracellulare Infection / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies
keywords: Mycobacterium - avium - intracellulare - lung biopsy - bronchoscopy