[Role of endoscopy for the diagnosis of tuberculosis]

The usefulness of bronchoscopy in diagnosis of pulmonary tuberculosis (PT) has been demonstrated with many workers after 1980's. The indication for bronchoscopy is in patients suspected of having active PT with negative sputum smear and polymerase chain reaction (PCR). The combination of bronchial aspiration, brushing, bronchoalveolar lavage, biopsy and postbronchoscopy sputum give a high yield of early diagnosis, ranging from 40-70% of cases. Furthermore, early diagnostic rate improves by these procedure adding PCR in 85%. The bacteriologic study of pleural effusion in diagnosis of tuberculous pleurisy has shown positive results in less than 30 percent of cases. Although the diagnostic rate improves in 60 percent by blind needle biopsy, the diagnostic accuracy is much greater when the thoracoscopy is used, because the pathologist is provided with multiple, selected biopsy. So not only surgeon but also physician should learn thoracoscopy for the diagnosis of pleural effusion.