Background: We previously classified forms of
endobronchial tuberculosis (EBTB) into seven subtypes by bronchoscopic
finding: actively caseating, edematous-hyperemic, fibrostenotic,
tumorous, granular, ulcerative, and nonspecific bronchitic.
Study objective: To evaluate the value of this
classification in predicting the therapeutic outcome of EBTB.
Design: A prospective study with serial bronchoscopy
performed from the diagnosis of EBTB to the completion of
Eighty-one patients with biopsy-proven EBTB.
Interventions: Fiberoptic bronchoscopy was done every month
until there was no subsequent change in the endobronchial lesions,
every 3 months thereafter, and at the end of treatment.
Results: Twenty-two of the 34 cases of actively caseating
EBTB changed into the fibrostenotic type, and the other 12 healed
without sequelae. Seven of the 11 cases of edematous-hyperemic EBTB
changed into the fibrostenotic type, and the other 4 healed. Nine of
the 11 cases of granular EBTB, 6 cases of nonspecific bronchitic EBTB,
and 2 cases of ulcerative EBTB resolved completely. However, the other
two cases of granular EBTB changed into the fibrostenotic type. Seven
cases of fibrostenotic EBTB did not improve despite antituberculosis
chemotherapy. These various changes in bronchoscopic findings occurred
within 3 months of treatment. In 10 cases of tumorous EBTB, 7
progressed to the fibrostenotic type. In addition, new lesions appeared
in two cases, and the size of the initial lesions increased in another
two cases, even at 6 months after treatment.
Conclusions: The therapeutic outcome of each subtype of
EBTB can be predicted by follow-up bronchoscopy during the initial 3
months of treatment, with the exception of the tumorous type. In
tumorous EBTB, close and long-term follow-up is advisable because the
evolution of the lesions during treatment is very complicated and
bronchial stenosis may develop at a later time.