Tissue sample taken by transbronchial biopsy in the diagnosis of tuberculosis; benefits-risks

Tuberculosis (TB) poses a serious health risk in Turkey and globally and is often difficult to diagnose. It may be sometimes necessary to obtain bronchoalveolar lavage (BAL) and, in some cases, biopsy samples via bronchoscopy to acquire an adequate sample. Our aim is to assess the contribution of transbronchial lung biopsy (TBLB) alongside BAL in diagnosing TB. In addition, we will evaluate the risk of pneumothorax associated with TBLB and determine the overall risk-benefit ratio.

Flexible fiberoptic bronchoscopy (FFB) reports performed for suspected TB between March 2011 and July 2018 were retrospectively reviewed. Patients who had both BAL and tissue samples taken via TBLB were included in the study. Of the 606 patients included, age, sex, the lung area where the biopsy was taken, BAL and biopsy AFB and culture results, and complications such as pneumothorax and chest tube application were recorded.

A total of 606 patients were included in the study. Of these, 391 patients were male (64.5%) and 215 were female (35.5%). A total of 37 (6.1%) patients had a positive culture for TB. Nineteen (59.4%) patients were positive on both BAL and tissue culture, while 5 patients were only positive on tissue culture. Pneumothorax developed in 34 patients (5.6%), 28 of whom required a chest tube.

Using various modalities such as BAL and TBLB together for diagnosing pulmonary TB can be advantageous when appropriate, particularly given the absence of significant complications during the procedure. Our findings indicate that incorporating TBLB alongside BAL impacted the diagnosis of pulmonary TB.