Bronchoscopic biopsies with radial endobronchial ultrasonographic navigation in the diagnosis of tuberculosis and mycobacteriosis in patients with peripheral lung masses

Abstract

The objective of the study: to evaluate the effectiveness of diagnosis of tuberculosis and mycobacteriosis in bronchobiopsy specimens obtained during navigation by radial endobronchial ultrasonography (rEBUS) in patients with peripheral lung lesions without bacterial excretion.Subjects and methods. A retrospective analysis of the diagnostic effectiveness of bronchoscopic examination with biopsies was carried out in 179 patients (75 men and 104 women) suffering from pulmonary tuberculosis or mycobacteriosis without bacterial excretion; peripheral lung lesions had been visualized by computed tomography (CT). The patients were divided into two groups: 93 underwent bronchoscopy with biopsies with rEBUS navigation, 86 underwent bronchoscopy with classical biopsies and preliminary CT navigation. Each patient underwent multiple biopsies, at least one fluid biopsy (bronchoalveolar lavage or bronchial lavage), and one tissue biopsy (transbronchial lung biopsy or brush biopsy). Specimens collected by all types of bronchobiopsy were sent for microbiological and cytological tests, specimens of pulmonary transbronchial biopsy were additionally sent for histological examination.Results. The diagnosis of tuberculosis was verified by bronchobiopsy in 106 (67.5%) of 158 patients with tuberculosis, but statistically significantly more often in the group with rEBUS navigation versus the group without it – 81.9% (68/83) versus 50.7% (38/75), respectively (pχ2 < 0.01). The diagnosis of non-tuberculous mycobacteriosis was verified by bronchobiopsy in 13 (61.9%) of 21 patients, in the group with rEBUS navigation – in 80.0% (8/10) patients, in the group without it – in 45.5% (5/11) (pφ > 0.05). The use of rEBUS navigation while collecting bronchobiopsy specimens made it possible to increase the etiological verification of tuberculosis using the following microbiological methods: microscopy – from 14.7 to 49.4% (pχ2 < 0.01), molecular genetic – from 41.3 to 72.3% ( pχ2 < 0.01), culture (Bactec MGIT960) – from 44.0 to 67.5% (pχ2 < 0.01) The greatest enhancement of diagnostic effectiveness was achieved in the specimens of bronchoalveolar lavage and bronchial lavage – from 33.3 to 71.1% (pχ2 < 0.01) and in brush biopsy specimens – from 25.6 to 57.6% (pχ2 < 0.01).