Comparative efficacy of BAL versus bronchial washing in smear-negative pulmonary TB

Abstract

<b>Background:</b> Data regarding efficacy of BAL and bronchial washing (BW) in diagnostics of smear-negative pulmonary TB are still controversial. <b>Aim:</b> To estimate efficacy of BAL vs BW in diagnostics of pulmonary TB in a tertiary care center. <b>Methods:</b> 63 pts (33 females, mean age 36,5 yrs) with suspected pulmonary TB according to CT scan with smear-negative sputum results, referred for diagnostic bronchoscopy, were consecutively included into study. Patients were randomized with 1:1 ratio for BAL or BW during flexible bronchoscopy, performed under local anesthesia. Obtained material was sent for luminescent microscopy, real-time PCR test, BACTEC culture and conventional LY culture. Frequency of mycobacteria detection for each method (and combined) was assessed. <b>Results:</b> In BAL group (34 pts) frequency of mycobacteria detection reached 23.5%, 14.7%, 23.5%, 23.5% for microscopy, RT-PCR, BACTEC and LY culture, respectively. In BW group (29 pts) the same parameters reached 41.4%, 17.2%, 13.8%, 10.3% respectively. Frequency of MBT detection by any technique reached 32.4% and 48.3% for BAL vs BW, respectively. In any comparison, differences were not statistically significant (p&gt;0.05). <b>Conclusion:</b> In our study, BAL looks more promising comparing with BW in culture confirmation of pulmonary TB in terms of BACTEC and LY seeds, but less sensitive than BW in terms of PCR and microscopy detection. More data are needed to further analyze these two diagnostic modalities.