title: Do we need transbronchial lung biopsy if we have bronchoalveolar lavage Xpert® MTB/RIF?
abstract: BACKGROUND
  Studies evaluating the role of transbronchial lung biopsy (TBLB) in diagnosing pulmonary tuberculosis (PTB) date back decades and have shaped current practice. However, with the recent advent of bronchoalveolar lavage (BAL) Xpert® MTB/RIF, it is time to re-evaluate the role of TBLB.
  
  
  OBJECTIVE
  To assess the impact of BAL and TBLB with the addition of BAL Xpert on diagnostic PTB yields and time to treatment initiation in sputum-scarce or acid-fast bacilli (AFB) smear-negative PTB patients.
  
  
  METHODS
  We retrospectively reviewed all sputum-scarce or AFB smear-negative patients who underwent both BAL and TBLB for suspected PTB between March 2011 and October 2013. Xpert was performed on all BAL specimens.
  
  
  RESULTS
  Of 158 patients included in our analysis, 44 were culture-proven PTB. Ninety-four per cent of the patients had AFB smear-negative BAL samples. The sensitivity and specificity of Xpert in AFB smear-negative BAL samples were respectively 60% and 98%. The addition of BAL Xpert expedited the institution of PTB treatment while having diagnostic yields comparable to those of conventional BAL with TBLB.
  
  
  CONCLUSIONS
  The use of BAL Xpert may obviate the need for TBLB in increasing the diagnostic yield of PTB in sputum-scarce or AFB smear-negative patients.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: Y
authors.initials: Y
authors.lastname: Mok
authors.affiliation: Department of Laboratory Medicine, Changi General Hospital, Singapore.
authors.forename: T Y
authors.initials: TY
authors.lastname: Tan
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: T R
authors.initials: TR
authors.lastname: Tay
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: H S
authors.initials: HS
authors.lastname: Wong
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: P Y
authors.initials: PY
authors.lastname: Tiew
authors.affiliation: Clinical Trials and Research Unit, Changi General Hospital, Singapore.
authors.forename: J W
authors.initials: JW
authors.lastname: Kam
authors.affiliation: Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
authors.forename: C
authors.initials: C
authors.lastname: Siao
mesh_terms: D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D001431:Bacteriological Techniques; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology*; D004269:DNA, Bacterial / Q000235:genetics* / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial / Q000235:genetics*; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D013183:Sputum / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology
chemical_list: D000904:Antibiotics, Antitubercular; D004269:DNA, Bacterial; D012293:Rifampin