The role of fiberoptic bronchoscopy procedures in the diagnostic of pulmonary tuberculosis

Objective: To evaluate the role of bronchial and lung biopsies in comparison to bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary tuberculosis (TB). Methods: Three-year retrospective study with 372 patients with clinical and/or radiological suspicion of TB that underwent bronchoscopy. BAL was performed in all patients, bronchial biopsies (BB) in 25 (6.7%) and transbronchial lung biopsies(TBLB) in 98 (26.3%). BAL samples were submitted to microbiological and cytological analysis, whereas BB and TBLB samples were presented to mycobacterial examination and culture and histopathological examination. Results: Of the 372 patients, 161 (43.3%) were diagnosed by bronchoscopy subsidiaries techniques: bacterial and fungal infections in 95 (25.5%); pulmonary tuberculosis in 48 (12.9%); lung cancer in 9 (2.4%); non-infectious granulomatous disease in 6 (1.6%); and nontuberculous mycobacterial infections in 3 (0.8%). In the TB group (n=48), BAL was diagnostic in 46 patients (44 positive BAL culture and 2 positive PCR test); BB where positive in 7 cases and TBLB in 5 cases. All patients with positive BB had bronchial mucosa abnormalities and in 2 patients it was the only positive result for TB. BB and BPTB accounted for 7 and 18 alternative results, respectively. Minor post-procedure complications occurred in only 1.9% of the cases. Conclusions: Despite not significantly impacting TB diagnosis, bronchial and lung biopsies facilitated the differential diagnosis with other pulmonary diseases.