The significance of radial endosonography of the lung parenchyma in the bronchoscopic diagnosis of peripheral pulmonary lesions of tuberculous genesis


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Abstract

The minimally invasive differential diagnosis of peripheral pulmonary lesions (PPLs) is an urgent clinical problem, especially in high tuberculosis (TB) burden countries. Objective: to evaluate the comparative effectiveness of bronchoscopic biopsies with radial endobronchial ultrasonography (rEBUS navigation) and biopsies in conventional bronchoscopy (BS) with computed tomography (CT)-guided navigation in the diagnosis of PPLs of non-cancer genesis. Subjects and methods. The investigation enrolled 158 patients (78 males, 80 females) with PPLs, as evidenced by chest CT (CCT), and with a negative sputum microbiological test for Mycobacterium tuberculosis. The patients were divided into 2 groups: 1) 82 patients undergoing BS with rEBUS navigation; 2) 76 patients having BS with CT-guided navigation. For a comprehensive microbiological and cytomorphological study after rEBUS navigation, the patients underwent bronchoalveolar lavage (BAL) (n=121), brush biopsy (n=103), bronchial washings (n=31), and transbronchial lung biopsy (n=25). Results. The diagnosis of TB was verified with BS in 103 (65.2%) patients; it was significantly more often in the samples from the patients undergoing rEBUS navigation than from those having CT-guided navigation (80.5% vs. 48.7% of cases, respectively; p<0.01). The addition of rEBUS navigation to BS with CT-guided navigation could increase the verification of TB: from 15.8% to 54.9% with microscopy (p<0.01), from 43.4% to 69.5% with the diagnosis with polymerase chain reaction (p<0.01), from 38.2% to 67.1% with a culture method (p<0.01) with the most effective diagnosis in the samples using BAL (36.2% vs. 59.6%; p<0.05) and cytological brushes (32.5% vs. 61.2%; p<0.01). Conclusion. The use of rEBUS navigation with BS increases TB diagnosis by 25-30%.

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About the authors

I. Yu Shabalina

Central Research Institute of Tuberculosis

Candidate of Medical Sciences

Yu. V Turovtseva

Central Research Institute of Tuberculosis

A. I Popova

Central Research Institute of Tuberculosis

T. G Smirnova

Central Research Institute of Tuberculosis

Candidate of Medical Sciences

E. E Larionova

Central Research Institute of Tuberculosis

Candidate of Biological Sciences

N. L Karpina

Central Research Institute of Tuberculosis

MD

A. E Ergeshov

Central Research Institute of Tuberculosis

Professor

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