Limited value of transbronchial lung biopsy for diagnosing <scp>M</scp>ycobacterium avium complex lung disease

Sekine, Akimasa; Saito, Takefumi; Satoh, Hiroaki; Morishita, Yukio; Tsunoda, Yoshiya; Tanaka, Toru; Yatagai, Yohei; Lin, Shih-Yuen; Miyazaki, Kunihiko; Miura, Yukiko; Hayashihara, Kenji

doi:10.1111/crj.12459

Cited by 10 publications

(8 citation statements)

References 11 publications

(16 reference statements)

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“…Our results strongly suggest that bronchoscopy can clarify whether or not major excretory lesions are localized; purulent excretion was limited to the bronchus of one lobe, and sputum smear conversion was obtained after surgically resecting the major excretory lesion, as shown in Table. In addition, we also previously reported that intrabronchial secretion can be a manifestation of ongoing airway damage, indicating the need for further treatment (13). Taken together, these present and previous findings suggest that bronchoscopy should be considered for investigating whether or not intrabronchial secretion is localized in refractory MAC patients with bilateral lesions.…”

Section: Discussionmentioning

confidence: 80%

Bronchoscopy as a Useful Examination for Determining Surgical Treatment Indications in Refractory Mycobacterium avium Complex Lung Disease Patients with Bilateral Lesions

et al. 2019

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We herein report three cases of refractory Mycobacterium avium complex (MAC) disease successfully treated surgically despite the MAC lesions being present bilaterally. Of note, although two patients did not present with any respiratory symptom, bronchoscopy clearly revealed a major excretory lesion with a large amount of purulent sputum in all patients. Because an excretory lesion was localized, surgical resection was performed, and the mycobacterial sputum smear became negative in all patients. Bronchoscopy may be a useful examination for detecting major excretory lesions with purulent sputum, which can disseminate to other lobes, and for determining the surgical indications of refractory MAC patients, regardless of the presence of respiratory symptoms.

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Section: Discussionmentioning

confidence: 80%

Bronchoscopy as a Useful Examination for Determining Surgical Treatment Indications in Refractory Mycobacterium avium Complex Lung Disease Patients with Bilateral Lesions

et al. 2019

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“…However, there are a few reports on using tissue specimens via TBB for TB culture. Several studies have revealed that specimens obtained via bronchial washing were more sensitive for culture positivity than specimens obtained via TBB; therefore, using TBB for bacterial investigations is of limited diagnostic value ( Chan et al, 1992 ; Sekine et al, 2017 ). Unlike the traditional transbronchial lung sampling method, which does not use a guiding system in the previous study, utilizing EBUS can help confirm the location of the lesions, and assist the operators in choosing a better site for biopsy.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Endobronchial Ultrasound-Guided Transbronchial Biopsy Combined With Tissue Culture for the Diagnosis of Sputum Smear-Negative Pulmonary Tuberculosis

Lin

Fan

et al. 2022

Front. Microbiol.

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BackgroundMicroorganisms of tuberculosis (TB) are frequently difficult to identify from the airway specimen; therefore, lung biopsy for further histologic and microbiologic study is required. Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of pulmonary malignancy, but is rarely in the TB population. The purpose of this study was to verify the effectiveness and safety of EBUS-TBB with histologic study and tissue culture in the diagnosis of sputum smear-negative pulmonary TB.MethodsPatients who underwent EBUS-TBB with histologic study and TB tissue culture for clinically suspected, but sputum smear-negative pulmonary TB from January 2016 to December 2018, were included. The accuracy of each diagnostic modality was calculated, respectively. Factors that might influence the positive rate of TB culture (washing fluid and tissue specimen) were also evaluated.ResultsOne hundred sixty-one patients who underwent EBUS-TBB for clinically suspected, but sputum smear-negative pulmonary TB, were enrolled, and 43 of them were finally diagnosed as having pulmonary TB. The sensitivity of washing fluid (a combination of smear, culture, and polymerase chain reaction for TB) and tissue specimen (a combination of pathology and tissue culture) via EBUS-TBB for TB diagnosis were 48.8 and 55.8%, respectively. The sensitivity for TB diagnosis would be elevated to 67.4% when both washing fluid and tissue specimens are used. The positive TB culture rate would not statistically increase with a combination of tissue specimens and washing fluid. Univariate analysis revealed that TB microorganisms would be more easily cultivated when lesions had an abscess or cavity on the computed tomography (CT) image (presence vs. absence; 62.5 vs. 26.3%, p = 0.022), heterogeneous echogenicity on the EBUS finding (heterogeneous vs. homogeneous; 93.3 vs. 21.4%, p = 0.001), or a necrotic pattern via histologic study (presence vs. absence; 70.6 vs. 30.8%, p = 0.013). Heterogeneous echogenicity in the EBUS finding was the independent predictor according to the results of multivariate analysis. None of our patients encountered major adverse events or received further intensive care after EBUS-TBB.ConclusionEndobronchial ultrasound-guided transbronchial biopsy is safe and effective for use in diagnosing sputum smear-negative pulmonary TB. EBUS echoic feature is also a predictor of the positive TB culture rate in pulmonary TB. However, tissue culture via EBUS-TBB has little effect in improving the positive TB culture rate.

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“…Several studies investigated the diagnostic accuracy of bronchoscopy for NTM [5][6][7][8][9][10][11][12][13][14]. Some performed bronchoscopy for patients with chest CT findings suggestive of pulmonary NTM disease, during a defined period [5,13,14]; however, the bronchoscopy procedure differed between studies.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…According to an American Thoracic Society (ATS)/Infectious Diseases Society of America (IDSA) statement published in 2007 [4], diagnosis of pulmonary NTM disease (including Mycobacterium avium complex [MAC], M. kansasii, and M. abscessus) requires a positive culture result for at least 2 separate expectorated sputum samples or at least 1 bronchial lavage sample. Bronchoscopy was reported to be useful for diagnosis of pulmonary NTM infection in patients with negative sputum cultures for NTM [5][6][7][8][9][10][11][12][13][14]; however, the bronchoscopy procedures for NTM diagnosis are not standardized. In addition, no previous study investigated the diagnostic accuracy of bronchial washing with or without bronchial brushing.…”

Section: Introductionmentioning

confidence: 99%

Bronchial Brushing and Diagnosis of Pulmonary Nontuberculous Mycobacteria Infection

et al. 2021

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Background: The optimal bronchoscopy procedure for diagnosis of pulmonary nontuberculous mycobacteria (NTM) infection is unclear. Objective: This study investigated the usefulness of bronchial brushing in bronchoscopy for diagnosis of pulmonary NTM infection in patients with suspected NTM lung disease and nodular bronchiectasis on chest computed tomography (CT) images. Methods: Bronchoscopy was prospectively performed for 69 patients with clinically suspected pulmonary NTM infection on chest CT from December 2017 through December 2019. Before and after bronchial brushing, bronchial washing was performed with 20 or 40 mL of normal sterile saline at the same segmental or subsegmental bronchi. Before and after bronchial brushing, samples of the washing fluid (pre- and postbrushing samples) and brush deposits (brush samples) were obtained and cultured separately. Results: NTM was detected in 37 of the 69 (53.6%) patients (Mycobacterium avium in 27, Mycobacterium intracellulare in 7, M. abscessus in 2, and M. kansasii in 2). NTM was detected in 34 (49.3%) prebrushing samples, in 27 (39.1%) postbrushing samples, and in 20 (29.0%) brush samples from the 69 patients. In 2 (2.9%) patients, NTM was detected only in postbrushing samples; in 1 (1.4%) patient, NTM was detected only in a brush sample. As compared with bronchial washing only, additional bronchial brushing increased the NTM culture-positive rate by 4.3% (3/69). Bronchial brushing caused bleeding, requiring hemostasis in 5 (7.2%) patients. Conclusion: Additional bronchial brushing increased the NTM culture-positive rate by only 4.3% (3/69), as compared with bronchial washing alone. Thus, the usefulness of brushing appears to be limited.

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Limited value of transbronchial lung biopsy for diagnosing Mycobacterium avium complex lung disease

Abstract: TBLB for pathological and bacterial investigations would provide only a limited value for MAC diagnosis. Moreover, the presence of intrabronchial secretion may be an important manifestation of ongoing airway damage, which would require early treatment.

Cited by 10 publications

References 11 publications

Bronchoscopy as a Useful Examination for Determining Surgical Treatment Indications in Refractory <i>Mycobacterium avium</i> Complex Lung Disease Patients with Bilateral Lesions

Bronchoscopy as a Useful Examination for Determining Surgical Treatment Indications in Refractory <i>Mycobacterium avium</i> Complex Lung Disease Patients with Bilateral Lesions

Effectiveness of Endobronchial Ultrasound-Guided Transbronchial Biopsy Combined With Tissue Culture for the Diagnosis of Sputum Smear-Negative Pulmonary Tuberculosis

Bronchial Brushing and Diagnosis of Pulmonary Nontuberculous Mycobacteria Infection

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