Despite previous reports on the results of fiberoptic bronchoscopy (FOB) in patients suspected to have Pneumocystis carinii pneumonia (PCP), controversy still exists regarding the role of transbronchial biopsy (TBbx) in addition to bronchoalveolar lavage (BAL) in these patients. The goal of the study was to evaluate the role of TBbx in addition to BAL in the evaluation of patients suspected to have PCP.
A retrospective chart review of all the HIV positive patients, who were sputum negative for PCP, and who underwent FOB in 2002 and 2003 for suspicion of PCP. Results of TBbx and BAL and adequacy of specimen were reviewed.
164 patients underwent FOB. 125 had TBbx and BAL done; six of these patients were excluded from analysis due to poor specimens. In the 119 patients analyzed, 39 were PCP positive (Analysis in table 1); in the remaining 80 patients who underwent TBbx and BAL, the TBbx supported an alternative diagnosis in 47 (59%) patients; tuberculosis (4), malignancy (1), sarcoidosis (1), Cytomegalovirus (2) and inflammatory changes consistent with pneumonia (39) was found with the TBbx. BAL alone was done in 39 patients; PCP was identified in 8 of them. Only one patient who underwent biopsy had a complication namely bleeding, which was easily controlled.
Yield of FOB for Pneumocystis carinii pneumoniaFOBTBbx + BAL +TBbx + BAL -TBbx − BAL +PCP+ n=3927 (69%)10 (26%)2 (5)
TBbx increases the diagnostic yield, in patients suspected to have PCP. BAL alone had a yield of 74% (29/39), whereas the yield from TBbx and BAL was 95% (37/39). In 10/39 (26%) of patients, the diagnosis of PCP was obtained only by TBbx. TBbx also provided alternative diagnosis such as tuberculosis and malignancy.
We recommend that where possible, both BAL and TBbx be done in patients suspected to have PCP, as it improves the diagnostic yield and provides incremental diagnosis without significantly increasing the complications. Performing BAL alone carries the risk of missing the diagnosis in a significant number of patients.
V. Lakshmi, None.