Bronchoscopy for the diagnosis of nontuberculous mycobacterial pulmonary disease: Specificity and diagnostic yield in a retrospective cohort study |
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| Affiliation: | 1. Department of Pulmonary Medicine, Thoracic Center, St. Luke''s International Hospital, St. Luke''s International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan;2. Graduate School of Public Health, St. Luke''s International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan;3. Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan;1. Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;2. Department of Pulmonary Immunotherapeutics, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;3. Internal Medicine, Kudanzaka Hospital, 1-6-12 Kudan-minami, Chiyoda-ku, Tokyo, 102-0074, Japan;1. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan;2. Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan;3. Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan;4. Department of Cardiovascular Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan;1. Department of Pediatrics, Tokai University School of Medicine, Japan;2. Department of Pediatrics, Tokai University Hachioji Hospital, Japan;3. Department of Respiratory Medicine, Tokai University Hachioji Hospital, Japan;1. Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey;2. Department of Infectious Diseases, Ankara Training and Research Hospital, Ankara, Turkey;3. Department of Radiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey;1. Department of Respiratory Medicine, Okayama City Hospital, 3-20-1, Kitanagaseomote-cho, Kita-Ku, Okayama, 700-8557, Japan;2. Department of Cardiovascular Medicine, Okayama City Hospital, 3-20-1, Kitanagaseomote-cho, Kita-Ku, Okayama, 700-8557, Japan;3. Department of Radiology, Okayama City Hospital, 3-20-1, Kitanagaseomote-cho, Kita-Ku, Okayama, 700-8557, Japan |
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| Abstract: | BackgroundBronchoscopy is a recognized method for obtaining specimens for the diagnosis of nontuberculous mycobacterial pulmonary disease (NTM-PD). However, its diagnostic properties remain to be elucidated. The aim of this study was to determine the specificity of bronchoscopy for the diagnosis of NTM-PD, and to examine the diagnostic yield of bronchoscopy for detecting nontuberculous mycobacteria (NTM) when patients cannot expectorate sputum with NTM.MethodsThis retrospective cohort study included 2657 patients who underwent bronchoscopy and mycobacterial culture between January 2004 and June 2018 in a tertiary care center in Tokyo, Japan. To examine the specificity of bronchoscopy, the first cohort comprised patients who underwent bronchoscopy for the diagnosis of lung cancer and mycobacterial culture. To investigate the diagnostic yield, patients with nodular bronchiectasis who underwent bronchoscopy for the diagnosis of NTM-PD were enrolled into the second cohort.ResultsIn total, 919 patients were diagnosed with lung cancer, 19 patients showed positive culture for NTM, and 14 patients showed findings for NTM-PD. Accordingly, the specificity was calculated as 900/905 (99.4%). In addition, NTM-PD was suspected before bronchoscopy in 199 patients; the diagnostic yield was 105/199 (52.8%). Four factors were associated with NTM-PD: upper lobe examination, absence of specific bacteria, absence of connective tissue disease, and a higher total computed tomography score.ConclusionsBronchoscopy has a high specificity for the diagnosis of NTM-PD. In addition, even when NTM is undetected in sputum, bronchoscopy may detect mycobacteria in approximately half of the patients suspected of having NTM-PD. |
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