Bronchoscopic Strategies to Improve Diagnostic Yield in Pulmonary Tuberculosis Patients

Kim, Saerom; Eom, Jung Seop; Mok, Jeongha

doi:.0..

Tuberc Respir Dis > Epub ahead of print

Review

DOI: https://doi.org/10.4046/trd.2024.0020 [Epub ahead of print]
Published online March 28, 2024.

Bronchoscopic Strategies to Improve Diagnostic Yield in Pulmonary Tuberculosis Patients

Saerom Kim, M.D.^1,2

, Jung Seop Eom, M.D., Ph.D.^1,2,3

, Jeongha Mok, M.D., Ph.D.^1,2,3

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 tuberculosis (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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ORCID iDs

Saerom Kim
https://orcid.org/0000-0002-5093-1503

Jung Seop Eom
https://orcid.org/0000-0002-0832-1314

Jeongha Mok
https://orcid.org/0000-0001-7406-1373

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