Diagnosis of sputum smear-negative forms of pulmonary tuberculosis by transthoracic fine-needle aspiration

We reviewed 25 patients submitted to transthoracic fine-needle aspiration (TFNA) who had a final diagnosis of pulmonary tuberculosis. In all cases, bacteriological stains and cultures of sputum and bronchial washing had been performed before admission and were negative. According to the material obtained from the procedure, the aspirates were divided in three groups: diagnostic (Ziehl-Neelsen and/or culture positive, n = 8, 32%), suggestive (granulomatous inflammatory changes, n = 10, 40%) and inconclusive (nonspecific inflammatory changes, isolated giant cells and/or blood, n = 7, 28%). On chest X-ray, 12 patients had opacities with the greatest diameter not exceeding 4 cm. All aspirates in the diagnostic group were from patients with this type of lesion, while all the inconclusive aspirates belonged to patients with larger lesions. As complications, 1 patient needed thoracic drainage for pneumothorax and 3 patients had haemoptyses.

Thus TFNA has a place in the diagnosis of suspected pulmonary tuberculosis when more simple methods have failed, and its effectiveness seems to be increased when the lesions do not exceed 4 cm in diameter.