Diagnostic Yield of Fibre-optic Bronchoscopy in Sputum Smear-negative/Sputum Scarce, Clinico-radiologically Suspected Cases of Pulmonary Tuberculosis at Tertiary Care Centre
Veena Tharad, Madhurmay, Rajiv Kumar, Namita Srivastava, Nikhil GillAbstract
Background:
Pulmonary tuberculosis (PTB) remains a significant public health burden in India. Diagnosing PTB becomes challenging in sputum smear-negative or sputum-scarce patients despite clinical and radiological suspicion. Fibre-optic bronchoscopy (FOB), with bronchoalveolar lavage (BAL) and advanced diagnostics, may enhance early detection in such cases.
Objective:
To evaluate the diagnostic yield of FOB in sputum smear-negative/sputum-scarce, clinico-radiologically suspected PTB cases at a tertiary care centre.
Materials and Methods:
This prospective cross-sectional study included 100 adults with suspected PTB but negative or unavailable sputum smears. BAL samples collected during FOB were analysed using Ziehl–Neelsen staining, mycobacteria growth indicator tube (MGIT) liquid culture and GeneXpert MTB Rif. Sensitivity, specificity, positive predictive value and negative predictive value of GeneXpert were compared with MGIT as the reference standard. Associations with past tuberculosis (TB) history and rifampicin resistance were also examined.
Results:
The study population was predominantly male (62%) and aged 31–50 years (63%). GeneXpert demonstrated a sensitivity of 91.3% and specificity of 100% compared to MGIT culture.
Conclusion:
FOB significantly improves diagnostic accuracy in smear-negative/sputum-scarce PTB. GeneXpert on BAL samples offers high sensitivity and specificity and assists in the early detection of rifampicin resistance. FOB should be considered in high-suspicion cases where initial sputum-based tests are inconclusive.