Lin Ching-Kai, Fan Hung-Jen, Yu Kai-Lun, Chang Lih-Yu, Wen Yueh-Feng, Keng Li-Ta, Ho Chao-Chi
Department of Medicine, National Taiwan University Cancer Center, Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
Front Microbiol. 2022 Apr 25;13:847479. doi: 10.3389/fmicb.2022.847479. eCollection 2022.
Microorganisms 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.
Patients 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.
One 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) 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%, = 0.022), heterogeneous echogenicity on the EBUS finding (heterogeneous vs. homogeneous; 93.3 vs. 21.4%, = 0.001), or a necrotic pattern histologic study (presence vs. absence; 70.6 vs. 30.8%, = 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.
Endobronchial 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 EBUS-TBB has little effect in improving the positive TB culture rate.
从气道标本中常常难以鉴定出结核分枝杆菌；因此，需要进行肺活检以进行进一步的组织学和微生物学研究。支气管内超声引导下经支气管活检（EBUS-TBB）用于诊断肺部恶性肿瘤，但在结核病患者中很少使用。本研究的目的是验证EBUS-TBB联合组织学研究和组织培养在痰涂片阴性肺结核诊断中的有效性和安全性。
纳入2016年1月至2018年12月期间因临床怀疑但痰涂片阴性的肺结核而接受EBUS-TBB联合组织学研究和结核组织培养的患者。分别计算每种诊断方法的准确性。还评估了可能影响结核培养阳性率（冲洗液和组织标本）的因素。
161例因临床怀疑但痰涂片阴性的肺结核而接受EBUS-TBB的患者入组，其中43例最终被诊断为肺结核。EBUS-TBB用于结核诊断时，冲洗液（结核涂片、培养和聚合酶链反应的组合）和组织标本（病理学和组织培养的组合）的敏感性分别为48.8%和55.8%。当同时使用冲洗液和组织标本时，结核诊断的敏感性将提高到67.4%。组织标本和冲洗液联合使用时，结核培养阳性率在统计学上不会增加。单因素分析显示，当病变在计算机断层扫描（CT）图像上有脓肿或空洞（存在与否；62.5%对26.3%，P = 0.022）、EBUS检查发现不均匀回声（不均匀对均匀；93.3%对21.4%，P = 0.001）或组织学研究有坏死模式（存在与否；70.6%对30.8%，P = 0.013）时，结核分枝杆菌更容易培养。根据多因素分析结果，EBUS检查发现的不均匀回声是独立预测因素。我们的患者在EBUS-TBB后均未发生重大不良事件或需要进一步的重症监护。
支气管内超声引导下经支气管活检在诊断痰涂片阴性肺结核方面安全有效。EBUS回声特征也是肺结核中结核培养阳性率的预测指标。然而，EBUS-TBB的组织培养对提高结核培养阳性率作用不大。
