Utility of Rapid On-Site Evaluation during Bronchoscopy in the Diagnosis of Pulmonary Tuberculosis.

IF 1.6 4区 医学 Q3 PATHOLOGY Acta Cytologica Pub Date : 2024-01-01 Epub Date: 2024-03-04 DOI:10.1159/000538094
Tao Wan, Qianfang Hu, Weiwei Hu, Hongli Deng, Dairong Li
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Abstract

Introduction: The diagnostic value of rapid on-site evaluation (ROSE) in bronchoscopy for lung tumors has been widely researched. However, the diagnostic efficacy of ROSE for pulmonary tuberculosis (TB) has not been extensively assessed yet. This study aimed to examine the value of ROSE in diagnosing pulmonary TB during bronchoscopy, and the relationship between ROSE cytology patterns and acid-fast bacilli (AFB) smears and mycobacterial cultures.

Methods: A retrospective study was conducted at a single respiratory endoscopy center, including 418 patients under clinical or radiological suspicion of having pulmonary TB who underwent bronchoscopy. In addition to the use of ROSE and definitive cytology, material obtained by aspiration/lavage or brushing was sent for AFB smear and mycobacterial culture. If histopathological examination was required, endobronchial biopsy, transbronchial lung biopsy, and transbronchial needle aspiration were performed at the discretion of the clinician. A composite reference standard (CRS) was used as the diagnostic gold standard for this study. The diagnosis obtained by ROSE was compared with the final diagnosis.

Results: Of the 418 patients studied, 282 (67.5%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary TB, in 238 (84.4%); non-TB, in 44 (15.6%). In 238 pulmonary TB patients, ROSE cytology showed granulomas without necrosis were observed in 107 cases, granulomas and necrosis in 51 cases, caseous necrosis only in 25 cases, and nonspecific inflammation in 55 cases. For the diagnosis of TB according to CRS, ROSE showed the sensitivity, specificity, positive predictive value, and negative predictive value were 76.9%, 68.2%, 92.9%, and 35.3%, respectively. The positivity rate for bacterial detection through acid-fast staining and culture during bronchoscopy was 51.7%. The cytological pattern showed a higher detection rate for bacteria in cases of necrosis.

Discussion: The application of ROSE during bronchoscopy is a straightforward procedure that delivers an immediate and precise assessment regarding the adequacy of collected samples, enabling a preliminary diagnosis of pulmonary TB. ROSE has exhibited a higher sensitivity in detecting pulmonary TB compared to microbiological examinations. In addition, the cytological presentation of ROSE tends to show a higher positivity rate for microbiological testing in caseous necrosis. Therefore, samples with these characteristics should be prioritized for microbiological examination after on-site evaluation.

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支气管镜检查中的现场快速评估在肺结核诊断中的实用性。
导言:现场快速评估(ROSE)在支气管镜检查肺部肿瘤中的诊断价值已得到广泛研究。然而,ROSE 对肺结核的诊断效果尚未得到广泛评估。本研究旨在探讨 ROSE 在支气管镜检查过程中诊断肺结核的价值,以及 ROSE 细胞学模式与酸性ast bacilli(AFB)涂片和分枝杆菌培养之间的关系。方法:在一家呼吸内镜中心进行了一项回顾性研究,包括418名临床或放射学怀疑患有肺结核并接受支气管镜检查的患者。除了使用 ROSE 和确定性细胞学检查外,还将抽吸/浸泡或刷洗获得的材料送去进行 AFB 涂片和分枝杆菌培养。如果需要进行组织病理学检查,则由临床医生决定是否进行支气管内活检(EBB)、经支气管肺活检(TBLB)和经支气管针吸活检(TBNA)。本研究采用综合参考标准(CRS)作为诊断金标准。将 ROSE 获得的诊断结果与最终诊断结果进行比较。结果:在研究的 418 名患者中,有 282 人(67.5%)根据支气管镜检查结果确诊为肺结核,占 238 人(84.4%);非肺结核,占 44 人(15.6%)。在 238 例肺结核患者中,ROSE 细胞学检查结果显示,107 例患者出现肉芽肿,但无坏死;51 例患者出现肉芽肿和坏死;25 例患者仅出现干酪样坏死;55 例患者出现非特异性炎症。根据 CRS、ROSE 诊断结核病的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为 76.9%、68.2%、92.9% 和 35.3%。在支气管镜检查中通过酸性染色和培养检测细菌的阳性率为 51.7%。细胞学模式显示,坏死病例的细菌检出率更高。讨论:在支气管镜检查过程中应用现场快速评估(ROSE)是一项简单易行的程序,可对采集样本的充分性进行即时、准确的评估,从而对肺结核做出初步诊断。与微生物检查相比,ROSE 在检测肺结核方面具有更高的灵敏度。此外,ROSE 的细胞学表现在病理坏死中往往显示出更高的微生物检测阳性率。因此,具有这些特征的样本应在现场评估后优先进行微生物检查。
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来源期刊
Acta Cytologica
Acta Cytologica 生物-病理学
CiteScore
3.70
自引率
11.10%
发文量
46
审稿时长
4-8 weeks
期刊介绍: With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.
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