Utilization of Bronchoscopy for Diagnosis in Clinically Suspected Pulmonary Tuberculosis Patients: A Diagnostic Study in Multiple Tertiary Hospitals in Indonesia

This study evaluates the diagnostic value of bronchoalveolar lavage (BAL) compared to sputum sampling in cases of pulmonary tuberculosis (TB), specifically focusing on acid-fast bacilli (AFB) staining, rapid molecular testing (RMT), and histopathological examination. We retrospectively analyzed 124 suspected pulmonary TB patients who underwent bronchoscopy—collected data encompassed demographic, clinical, radiological, microbiological, and pathological findings. The definitive diagnosis was based on bacteriological results obtained post-bronchoscopy. Results indicated that RMT of sputum had a sensitivity of 16.1%, slightly surpassing the 13.2% sensitivity of AFB staining in sputum, with both methods demonstrating perfect specificity (100%). The accuracy of RMT sputum (62.0%) was marginally higher than that of AFB sputum staining (61.9%), with both yielding an identical Area Under the Curve (AUC) value of 0.558. In contrast, RMT of BAL exhibited superior diagnostic performance, with a sensitivity of 43.6%, perfect specificity (100%), and an AUC of 0.702. Histopathological examination provided the highest sensitivity at 53.6%, albeit with lower specificity (67.6%) and an AUC of 0.627. AFB staining of BAL had a sensitivity of 16.4% while maintaining perfect specificity (100%), yielding an AUC of 0.567. Microbiology examination alone showed a sensitivity of 48.2%, achieving ideal specificity (100%), with an AUC of 0.721. Notably, an integrated microbiology-anatomical pathology approach significantly improved sensitivity to 87.5% (an absolute increase of 39.3%) and produced a better AUC value (0.781) despite a decrease in specificity. Overall, bronchoscopy demonstrated enhanced diagnostic value in patients with suspected pulmonary tuberculosis who had negative sputum examination results.