Clinical Utility of CT-Based Bronchial Aspirate TB-PCR for the Rapid Diagnosis of Pleural Tuberculosis.
10.4046/trd.2013.75.4.150
- Author:
Jaehee LEE
1
;
So Yeon LEE
;
Keum Ju CHOI
;
Jae Kwang LIM
;
Seung Soo YOO
;
Shin Yup LEE
;
Seung Ick CHA
;
Jae Yong PARK
;
Chang Ho KIM
Author Information
1. Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. kimch@knu.ac.kr
- Publication Type:Original Article
- Keywords:
Tuberculosis, Pleural;
Bronchoscopy;
Polymerase Chain Reaction;
Thoracoscopy
- MeSH:
Biopsy;
Bronchoscopy;
Humans;
Polymerase Chain Reaction;
Sputum;
Thoracoscopy;
Thorax;
Tuberculosis, Pleural*
- From:Tuberculosis and Respiratory Diseases
2013;75(4):150-156
- CountryRepublic of Korea
- Language:English
-
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.
