Use of the flexible fibreoptic bronchoscope in diagnosis of sputum-negative pulmonary tuberculosis.

In four years' use of the flexible fibreoptic bronchoscope in diagnosing sputum-negative pulmonary tuberculosis, of 275 patients with tuberculosis suspected from chest radiographic appearances, 89 (32.4%) were shown to have active disease. In 60 (67.4%) of these patients the diagnosis was made from samples obtained through the fibreoptic bronchoscope (56 from bronchial brushings, four from transbronchial biopsy samples). Of the 56 positive bronchial brushings, 35 were positive on direct smear and 21 only on culture. Transbronchial biopsy exclusively accounted for only four of the 60 positive diagnoses. In the remaining 29 patients, the diagnosis was made from further sputum or biopsy specimens in 15, from the response to treatment in 12, and at necropsy in two. In six of 10 patients with military tuberculosis, bronchial brushings were positive on direct smear.