Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Utility of CT-Based Bronchial Aspirate TB-PCR for the Rapid Diagnosis of Pleural Tuberculosis

  • Lee, Jaehee (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, So Yeon (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Choi, Keum Ju (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lim, Jae Kwang (Department of Radiology, Kyungpook National University School of Medicine) ;
  • Yoo, Seung Soo (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Shin Yup (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Cha, Seung Ick (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Jae Yong (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Chang Ho (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • Received : 2013.05.22
  • Accepted : 2013.06.25
  • Published : 2013.10.30
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Abstract

Background: Thoracoscopic pleural biopsy is often required for rapid and confirmative diagnosis in patients with suspected pleural tuberculosis (PL-TB). However, this method is more invasive and costly than its alternatives. Therefore, we evaluated the clinical utility of the chest computed tomography (CT)-based bronchial aspirate (BA) TB-polymerase chain reaction (PCR) test in such patients. Methods: Bronchoscopic evaluation was performed in 54 patients with presumptive PL-TB through diagnostic thoracentesis but without a positive result of sputum acid-fast bacilli (AFB) smear, pleural fluid AFB smear, or pleural fluid TB-PCR test. Diagnostic yields of BA were evaluated according to the characteristics of parenchymal lesions on chest CT. Results: Chest radiograph and CT revealed parenchymal lesions in 25 (46%) and 40 (74%) of 54 patients, respectively. In cases with an absence of parenchymal lesions on chest CT, the bronchoscopic approach had no diagnostic benefit. BA TB-PCR test was positive in 21 out of 22 (95%) patients with early-positive results. Among BA results from 20 (37%) patients with patchy consolidative CT findings, eight (40%) were AFB smear-positive, 18 (90%) were TB-PCR-positive, and 19 (95%) were culture-positive. Conclusion: The BA TB-PCR test seems to be a satisfactory diagnostic modality in patients with suspected PL-TB and patchy consolidative CT findings. For rapid and confirmative diagnosis in these patients, the bronchoscopic approach with TB-PCR may be preferable to the thoracoscopy.

Keywords

References

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