Tomishima Yutaka, Urayama Kevin Y, Kitamura Atsushi, Okafuji Kohei, Jinta Torahiko, Nishimura Naoki, Tamura Tomohide
Department of Pulmonary Medicine, Thoracic Center, St. Luke's International Hospital, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan; Graduate School of Public Health, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
Graduate School of Public Health, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan; Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
Respir Investig. 2022 May;60(3):355-363. doi: 10.1016/j.resinv.2021.11.012. Epub 2022 Jan 5.
Bronchoscopy is a recognized method for obtaining specimens for the diagnosis of nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its diagnostic properties remain to be elucidated. The aim of this study was to determine the specificity of bronchoscopy for the diagnosis of NTM-PD, and to examine the diagnostic yield of bronchoscopy for detecting nontuberculous mycobacteria (NTM) when patients cannot expectorate sputum with NTM.
This retrospective cohort study included 2657 patients who underwent bronchoscopy and mycobacterial culture between January 2004 and June 2018 in a tertiary care center in Tokyo, Japan. To examine the specificity of bronchoscopy, the first cohort comprised patients who underwent bronchoscopy for the diagnosis of lung cancer and mycobacterial culture. To investigate the diagnostic yield, patients with nodular bronchiectasis who underwent bronchoscopy for the diagnosis of NTM-PD were enrolled into the second cohort.
In total, 919 patients were diagnosed with lung cancer, 19 patients showed positive culture for NTM, and 14 patients showed findings for NTM-PD. Accordingly, the specificity was calculated as 900/905 (99.4%). In addition, NTM-PD was suspected before bronchoscopy in 199 patients; the diagnostic yield was 105/199 (52.8%). Four factors were associated with NTM-PD: upper lobe examination, absence of specific bacteria, absence of connective tissue disease, and a higher total computed tomography score.
Bronchoscopy has a high specificity for the diagnosis of NTM-PD. In addition, even when NTM is undetected in sputum, bronchoscopy may detect mycobacteria in approximately half of the patients suspected of having NTM-PD.
支气管镜检查是获取标本以诊断非结核分枝杆菌肺病（NTM-PD）的一种公认方法。然而，其诊断特性仍有待阐明。本研究的目的是确定支气管镜检查对NTM-PD诊断的特异性，并在患者无法咳出含NTM痰液时，检验支气管镜检查检测非结核分枝杆菌（NTM）的诊断率。
这项回顾性队列研究纳入了2004年1月至2018年6月在日本东京一家三级医疗中心接受支气管镜检查和分枝杆菌培养的2657例患者。为检验支气管镜检查的特异性，第一组队列包括因诊断肺癌而接受支气管镜检查和分枝杆菌培养的患者。为研究诊断率，将因诊断NTM-PD而接受支气管镜检查的结节性支气管扩张患者纳入第二组队列。
总共919例患者被诊断为肺癌，19例患者分枝杆菌培养呈阳性，14例患者有NTM-PD的表现。因此，特异性计算为900/905（99.4%）。此外，199例患者在支气管镜检查前被怀疑患有NTM-PD；诊断率为105/199（52.8%）。有四个因素与NTM-PD相关：上叶检查、无特定细菌、无结缔组织病以及较高的计算机断层扫描总分。
支气管镜检查对NTM-PD的诊断具有高特异性。此外，即使痰液中未检测到NTM，支气管镜检查也可能在大约一半疑似NTM-PD的患者中检测到分枝杆菌。
