Tuberc Respir Dis > Accepted Articles
DOI: https://doi.org/10.4046/trd.2024.0020    [Accepted]
Published online March 28, 2024.
Bronchoscopic strategies to improve diagnostic yield in pulmonary tuberculosis patients
Saerom Kim1,2, Jung Seop Eom1,2,3, Jeongha Mok1,2,3
1Department of Internal Medicine, Pusan National University Hospital, Busan, Republic of Korea
2Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
3Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
Correspondence:  Jeongha Mok, Tel: 82-51-240-7889, Fax: 82-51-254-3127, 
Email: mokgamokga@gmail.com
Received: 6 February 2024   • Revised: 18 March 2024   • Accepted: 26 March 2024
*Saerom Kim and Jung Seop Eom contributed equally to this study as co-first authors.
Abstract
In cases where pulmonary tuberculosis (PTB) is not microbiologically diagnosed via sputum specimens, bronchoscopy has been the conventional method to enhance diagnostic rates. Although the additional benefit of bronchoscopy in diagnosing PTB is well-known, its overall effectiveness remains suboptimal. This review introduces several strategies for improving PTB diagnosis via bronchoscopy. First, it discusses how bronchoalveolar lavage or an increased number of bronchial washings can increase specimen abundance. Second, it explores how thin or ultrathin bronchoscopes can achieve specimen acquisition closer to TB lesions. Third, it highlights the importance of conducting more sensitive TB-polymerase chain reaction tests on bronchoscopic specimens, including the Xpert MTB/RIF assay and the Xpert MTB/RIF Ultra assay. Finally, it surveys the implementation of endobronchial ultrasound with a guide sheath for tuberculomas, collection of post-bronchoscopy sputum, and reduced use of lidocaine for local anesthesia. A strategic combination of these approaches may enhance the diagnostic rates in PTB patients undergoing bronchoscopy.
Key Words: bronchoscopy, diagnosis, pulmonary, tuberculosis


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