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J Thorac Cardiovasc Surg 2009;138:179-184
© 2009 The American Association for Thoracic Surgery

Perioperative Management

Diagnostic value of endobronchial ultrasonography for pulmonary tuberculosis

Shu-Min Lin, MD, Fu-Tsai Chung, MD, Chien-Da Huang, MD, Wen-Te Liu, MD, Chih-Hsia Kuo, MD, Chun-Hua Wang, MD, Kang-Yun Lee, MD, PhD, Chien-Ying Liu, MD, Horng-Chyuan Lin, MD, Han-Pin Kuo, MD, PhD*

Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taipei, Taiwan

Received for publication November 21, 2008; revisions received March 5, 2009; accepted for publication April 1, 2009.

* Address for reprints: Han-Pin Kuo, MD, PhD, Department of Thoracic Medicine, Chang Gung Memorial Hospital, 199 Tun-Hwa N Rd, Taipei, Taiwan. (Email: q8828{at}ms11.hinet.net).

Objectives: We sought to compare the diagnostic yields of acid-fast bacilli smears and Mycobacterium tuberculosis cultures in terms of bronchoalveolar lavage fluid and histologic examination of transbronchial lung biopsy specimens for pulmonary tuberculosis by using bronchoscopy with versus without endobronchial ultrasonography in patients with negative acid-fast bacilli smears or no sputum production.

Methods: From June 2005 to July 2006, a total of 451 patients were given diagnoses of and treated for pulmonary tuberculosis in a university-affiliated hospital. Among them, 121 patients who received bronchoscopy because of sputum-negative conditions were recruited. Of these, 73 patients received bronchoscopy with endobronchial ultrasonography, and 48 patients received conventional bronchoscopy.

Results: Patients who received bronchoscopy with endobronchial ultrasonography had higher diagnostic yields of acid-fast bacilli smears (31.5% vs 12.5%, P = .018) in bronchoalveolar lavage fluid, M tuberculosis in bronchoalveolar lavage fluid (67.1% vs 47.9%, P = .024), and pathologic reports of tuberculosis in transbronchial lung biopsy specimens (32.9% vs 4.2%, P < .0001) than patients who received conventional bronchoscopy. With the aid of endobronchial ultrasonography, the overall diagnostic yield for tuberculosis by using bronchoscopic procedures (smears and cultures of bronchoalveolar lavage fluid and transbronchial lung biopsy specimens) was higher (80.8%) than for those who did not undergo endobronchial ultrasonography (58.3%, P = .035).

Conclusions: The addition of endobronchial ultrasonography to diagnostic bronchoscopy increased the sensitivity for proving the presence of tuberculosis in a population of patients with negative acid-fast bacilli smears or no sputum production.

Abbreviations and Acronyms BALF = bronchoalveolar lavage fluid; CT = computed tomography; EBUS = endobronchial ultrasonography; TBLB = transbronchial lung biopsy




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