Abstract
BackgroundThis 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.MethodsWe 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.ResultsOf 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%.ConclusionsFOB 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.
Highlights
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
Active PTB was diagnosed in 54 patients (42.9%), of which 48 (88.9%) had positive TB cultures and 6 (11.1%) cases were confirmed by pathology and Mycobacterium tuberculosis (MTB)-polymerase chain reaction (PCR)
Our study demonstrates that FOB and FOB with HRCT can play an important role in the rapid diagnosis of active PTB in sputum smear-negative patients suspected of TB
Summary
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. The global strategy to control TB is prompt diagnosis, notification, and successful treatment of patients with active, transmissible disease. Acid-fast bacilli (AFB) smears of respiratory specimens (at least two or more specimens) are important for the prompt diagnosis of PTB, but AFB smears have poor sensitivity (30–70%) despite high specificity (98–99%). The diagnosis of TB and the decision to start treatment against sputum smear-negative TB is usually dependent on clinical features, but 20% of PTB patients are completely asymptomatic whereas 42–86% of PTB patients may be symptomatic. Sputum smear-negative PTB patients are especially likely to show no or mild respiratory symptoms and systemic manifestations [5]
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