Role of Fiberoptic Bronchoscopy in Diagnosis of Pulmonary Tuberculosis in Patients at Risk for AIDS

Abstract

To the Editor: In an article that appeared in the May 1992 issue of Chest, Miro et al1Miro AM Gibilara E Powell S Kamholz SL The role of fiberoptic bronchoscopy for diagnosis of pulmonary tuberculosis in patients at risk for AIDS.Chest. 1992; 101: 1211-1214Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar conclude that transbronchial biopsy does not contribute significantly to the diagnosis of tuberculosis. Major shortcomings of this study and its conclusions should be pointed out. Of the 27 patients with HIV risk factors who underwent bronchoscopy, only 18 had clinical evidence of HIV infection. It is unclear whether findings based on this group of patients can be extrapolated to those who actually have HIV infection. In addition, it is difficult to understand why patients with acid-fast bacilli on sputum smear were included in the analysis, since bronchoscopy is not indicated for the diagnosis of tuberculosis in these cases. The authors state that transbronchial biopsy has been shown not to contribute to the diagnosis of tuberculosis in patients without HIV infection, and cite a study that evaluated only 12 patients.2Stenson W Aranda C Bevelaqua FA Transbronchial biopsy culture in pulmonary tuberculosis.Chest. 1983; 83: 883-884Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar A more balanced view of the literature indicates that histopathologic findings of granulomata on transbronchial biopsy provide the exclusive means for a rapid presumptive diagnosis of tuberculosis in 10 to 26 percent of patients with tuberculosis who undergo bronchoscopy.3Wallace JM Deutsch AL Harrell JH Moser KM Bronchoscopy and transbronchial biopsy in evaluation of patients with suspected active tuberculosis.Am J Med. 1981; 70: 1189-1194Abstract Full Text PDF PubMed Scopus (76) Google Scholar, 4Willcox PA Benatar SR Potgieter PD Use of the flexible fibreoptic bronchoscope in diagnosis of sputum-negative pulmonary tuberculosis.Thorax. 1982; 37: 598-601Crossref PubMed Scopus (62) Google Scholar, 5So SY Lam WK Yu DYC Rapid diagnosis of suspected pulmonary tuberculosis by fiberoptic bronchoscopy.Tubercle. 1982; 63: 195-200Abstract Full Text PDF PubMed Scopus (78) Google Scholar, 6Chawla R Pant K Jaggi OP Chandrashekhar S Thukral SS Fibreoptic bronchoscopy in smear-negative pulmonary tuberculosis.Eur Respir J. 1988; 16: 804-806Google Scholar, 7Al-Kassimi FA Al-Majed M Al-Wazzan AD Al-Hajjaj MS Malibary T Diagnostic role of fibreoptic bronchoscopy in tuberculosis in the presence of typical x-ray pictures and adequate sputum.Tubercle. 1991; 72: 145-148Abstract Full Text PDF PubMed Scopus (14) Google Scholar In a study of patients with HIV infection at our institution,8Kennedy DJ Lewis WP Barnes PF Yield of bronchoscopy for the diagnosis of tuberculosis in patients with human immunodeficiency virus infection.Chest. 1992; 102: 1040-1044Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar transbronchial biopsy provided the exclusive means for rapid diagnosis of tuberculosis in 6 of 59 cases. These data suggest that, despite the reduced frequency of granuloma formation in patients with HIV infection, transbronchial biopsy contributes incremental diagnostic information in some patients. The data presented in the report by Miro et al do not allow evaluation of the contribution of transbronchial biopsy to the rapid diagnosis of tuberculosis. The authors conclude that transbronchial biopsy cultures are not helpful, based on evaluation of only six patients. Meaningful conclusions cannot be drawn from such a limited sample. In summary, I believe that the conclusions of Miro and coworkers are supported neither by published reports nor by the data they present. Additional studies are needed to address the contribution of transbronchial biopsy to the diagnosis of tuberculosis in patients with HIV infection.