Role of Fibreoptic Bronchoscopy in the Diagnosis of Smear-Negative Pulmonary Tuberculosis (Code-T0355)

Introduction: Pulmonary tuberculosis (PTB) remains a major public health concern, 
especially in smear-negative cases, which pose diagnostic challenges. Smear-negative PTB 
can lead to delayed diagnosis, prolonged transmission, and increased morbidity. Fibreoptic 
bronchoscopy (FOB) is a valuable diagnostic tool that enables direct visualization and 
collection of lower respiratory tract samples to improve diagnostic accuracy. 
Aims and Objectives 
1. To study the role of FOB in smear negative cases of pulmonary tuberculosis or are unable 
to expectorate sputum but having clinical and radiological features highly suggestive of 
pulmonary tuberculosis 
2. Simultaneous detection of Rifampicin resistance 
Methods: This hospital-based prospective observational study was conducted at the 
Department of Pulmonary Medicine, Gauhati Medical College and Hospital. A total of 195 
patients meeting the inclusion criteria underwent FOB for sample collection, including 
bronchial washings, bronchoalveolar lavage (BAL), and transbronchial lung biopsy (TBLB). 
The collected samples were subjected to smear microscopy, mycobacterial culture, CBNAAT, 
and histopathology for diagnostic confirmation. 
Results: FOB significantly enhanced the detection of smear-negative PTB. Positive results 
were obtained through BAL smear, mycobacterial culture, and biopsy findings, demonstrating 
the utility of bronchoscopic procedures in early diagnosis. The study also identified cases of 
Rifampicin-resistant TB, emphasizing the role of FOB in guiding early treatment and 
preventing multidrug-resistant tuberculosis (MDR-TB). 
Conclusion: Fibreoptic bronchoscopy is an effective diagnostic tool for smear-negative PTB, 
aiding in early diagnosis and appropriate management. Its integration into clinical practice 
can reduce disease transmission and improve patient outcomes. 
Keywords: Pulmonary Tuberculosis, Fibreoptic Bronchoscopy, Smear-Negative TB, 
Bronchoalveolar Lavage, Mycobacterial Culture, Rifampicin Resistance.