Routine examination for tuberculosis is still indicated during bronchoscopy for pulmonary infiltrates

Tuberculosis (TB) can present in numerous ways and can be radiological indistinguishable from cancer. In several guidelines for bronchoscopy (FOB) in low-incidence areas, a Mycobacterium tuberculosis test is only recommended when TB is clinically suspected. Due to the expenses associated with M. tuberculosis cultures, we did an analysis of tests obtained by FOB and other invasive procedures (endoscopic ultrasound (EUS)-guided needle biopsy via the oesophagus or trachea and percutaneous needle lung biopsy (PNLB)).

All patients tested positive for M. tuberculosis by culture and with samples obtained by FOB, EUS or PNLB in the 2008-2012 period were identified retrospectively in two centres in a low-incidence area (Copenhagen, Denmark). Patient records and radiological reports were reviewed.

A total of 57 (1.2%) patients out of the 4,680 tested were M. tuberculosis culture positive. Of the 57 patients, 40.3% (n = 23) presented with isolated upper lobe infiltrates and 29.8% (17) with cavitating infiltrates. Isolated chest lymphadenopathy was seen in 8.8% (n = 5). In 33.3% (n = 19) of the patients, radiography was not typical of TB (not upper lobe, no cavity, not isolated lympadenopathy, not miliary). Of the 57 patients, 48 were diagnosed by FOB, six by EUS and three by PNLB. M. tuberculosis samples were taken in an estimated 34% of all procedures.

M. tuberculosis culturing should always be considered when performing FOB in patients with lung infiltrates of unknown origin, even in a low-incidence country as Denmark. EUS and PNLB should also be considered when sampling material.

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