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Background: Bronchoscopy is a mandatory tool used to diagnose endobronchial tuberculosis (EBTB); however, it is not routinely performed on all patients with pulmonary tuberculosis (PTB) because of the risk of exposure to airborne Mycobacterium tuberculosis. Early diagnosis of EBTB is essential for watchful waiting and treatment planning of residual bronchostenosis. Therefore, physicians need to determine the incidence of EBTB according to the implementation rate of bronchoscopy in each region and identify patients with PTB requiring bronchoscopy on initial evaluation. We evaluated the implementation rate of bronchoscopy among patients with PTB and assessed the incidence and risk factors of concomitant EBTB.
Materials and Methods: Overall, 335 patients diagnosed with PTB between May 2013 and April 2020 were included. The implementation rate of bronchoscopy in patients with PTB was determined. Additionally, the incidence of EBTB and their clinical characteristics were also evaluated.
Results: The implementation rate of bronchoscopy in patients with PTB was 26.9% (n = 90/335). The incidence of EBTB in all patients with PTB was 7.5% (n = 25/335) and of those who underwent bronchoscopy was 27.8% (n = 25/90). Among the 25 patients with EBTB, although 19 (76%) were suspected to have EBTB before bronchoscopy, six (24%) were incidentally diagnosed using bronchoscopy. A positive acid-fast bacilli (AFB) sputum smear [odds ratio (OR) 10.11, 95% confidence interval (CI) 3.20-31.95] and the presence of airway stenosis on computed tomography (CT) images (OR 4.58, 95% CI 1.41-14.88) were identified as independent risk factors of concomitant EBTB in patients with PTB.
Conclusions: The incidence of EBTB may be underestimated because of the low implementation rate of bronchoscopy. Physicians should consider bronchoscopy to diagnose the presence of concomitant EBTB in patients with PTB with either or both a positive AFB sputum smear and the presence of airway stenosis on CT images.
