Haluk C. ÇALIŞIR, Öner A. BALBAY, Arzu ERTÜRK, Mihriban ÖĞRETENSOY

Balgam yayma negatif akciğer tüberkülozu olgularında bronş lavajı, bronş biyopsisi ve postbronkoskopik balgamın tanısal değeri

Bu çalışma; balgam ve mide suyu yayma ve kültürü ile tanı konulamayan şüpheli akciğer tüberkülozu (Tbc) olgularında, fiberoptik bronkoskopi (FOB) eşliğinde bronş biyopsisi (BB), bronş lavajı (BL) ve postbronkoskopik balgamın (PBB) tanısal değerini araştırmak için yapıldı. Çalışma, klinik ve radyolojik olarak akciğer Tbc düşünülen, balgam ve mide suyunda teksifle aside rezistans basil (ARB) negatif bulunmuş 34 hastaya FOB uygulanarak gerçekleştirildi. ARB ve Tbc kültürü için BL ve PBB, histopatolojik inceleme için BB örnekleri alındı. Hastaların 25'ine (%74) akciğer Tbc tanısı konuldu. Bu 25 hastanın 19'una (%55.8) BB'de histopatolojik olarak kazeifiye granülamatöz iltihabın gösterilmesi ve/veya BL'de teksifle ARB pozitif bulunmasıyla erken dönemde tanı konulurken kalan 6 hastaya (%17.6) BL kültüründe ARB üremesi ile geç tanı konulabildi. PBB yayma ve/veya kültürü sadece 3 hastada pozitifti. Hastaların 9'una (%26) bronkoskopik olarak tanı konulamadı. Sonuç olarak; balgam ve mide suyunda teksifle ARB gösterilmeyen şüpheli Tbc olgularının çoğunda FOB eşliğinde alınan BB ve BL ile tanı konuldu. PBB tetkikiyle doğru tanıya yalnızca 3 olguda ulaşılabilmiştir. Bu nedenle BB ve BL'nin Tbc tanısında önemli yeri olduğu, PBB'nin ise rutin FOB incelemesinde araştırılmasına gerek olmadığı kanısındayız.

The diagnostic value of bronchial lavage, bronchial biopsy and postbronchoscopic sputum in smear-negative pulmonary tuberculosis

We evaluated the diagnostic value of fiberoptic bronchoscopy (FOB) in sputum and gastric lavage smear-negative pulmonary tuberculosis (Tbc). FOB was performed to 34 patients, suspected to be pulmonary Tbc radiologically and clinically. Bronchial biopsy (BB), bronchial lavage (BL), postbronchoscopic sputum (PBS) smears and cultures were gained for histopathologic and bacterial examination. The diagnosis of pulmonary tuberculosis was subsequently confirmed in 25 (74%) patients. With positive acid-fast bacilli smears and histopathology results, we obtained rapid and early diagnosis in 19 patients (55.8%) by a combination of BL smears (positive for acid-fast bacilli in BL smear) and BB examination (positive for caseous necrosis). The diagnosis of the remaining 6 patients (17.6%) was confirmed by BL culture positivity for Tbc . PBS smear and/or culture positivity was observed only in three patients (8.8%). We couldn't establish any diagnosis in 9 (26%) patients. We concluded that FOB should be useful in the diagnosis of Tbc using by BL, BB in smear negative suspected pulmonary tuberculosis. When done properly, bronchial biopsy and bronchial lavage give complemantary results and provide a diagnosis in most cases but Routine PBS examination was not recommended.

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