Diagnostic role of fiberoptic bronchoscopy in suspected smear negative pulmonary tuberculosis.

Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) was performed in 40 patients suspected to have pulmonary tuberculosis, in whom chest roentgenogram revealed minimal infiltration and sputum smears were negative for acid-fast bacilli. Bronchoscopic procedures provided overall diagnostic yields in 47.5% (19/40) of patients. The diagnostic yield of overall bronchoscopic procedures for tuberculosis in this study was 32.5% (13/40) of patients. It consisted of positive BAL smear in 7.5% (3/40) of patients, positive for mycobacterial culture in 15% (6/40) of patients and TBB revealing granuloma in 17.5% (7/40) of patients. Non-tuberculosis conditions were diagnosed by the bronchoscopic method in six patients (15%). These results suggest that in an area with a high prevalence of tuberculosis, bronchoscopic procedures should be performed in those cases in which other diagnoses such as malignancy must be ruled out. Transbronchial biopsy has a major role for early diagnosis and should be performed in all cases, if possible.