INT J TUBERC LUNG DIS 17(7):917–921

© 2013 The Union

http://dx.doi.org/10.5588/ijtld.12.0885
E-published ahead of print 23 April 2013

Diagnostic accuracy of Xpert® MTB/RIF on bronchoscopy

specimens in patients with suspected pulmonary tuberculosis

H. Y. Lee,* M. W. Seong,† S. S. Park,† S-S. Hwang,‡ J. Lee,* Y. S. Park,* C. H. Lee,* S-M. Lee,*
C-G. Yoo,* Y. W. Kim,* S. K. Han,* J-J. Yim*
* Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, and
† Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, ‡ Department of Social and

Preventive Medicine, School of Medicine, Inha University, Incheon, Republic of Korea

SUMMARY

O B J E C T I V E : To determine the diagnostic accuracy of
the Xpert® MTB/RIF assay using samples obtained
through bronchoscopy in patients with suspected pul-
monary tuberculosis (PTB).
D E S I G N : We retrospectively reviewed the records of pa-
tients with suspected PTB for whom the Xpert MTB/
RIF assay was performed on bronchoscopy specimens.
The sensitivity, specificity, positive predictive value (PPV)
and negative predictive value (NPV) for the diagnosis of
active PTB were calculated for acid-fast bacilli (AFB)
smear microscopy and the Xpert assay using culture of
Mycobacterium tuberculosis from sputum or bronchos-
copy specimens as a reference standard.
R E S U LT S : A total of 132 patients were included in the
final analysis. Of these, 38 had culture-confirmed PTB.
The sensitivity of the Xpert assay using bronchial wash-
ing or bronchoalveolar lavage (BAL) fluid for the diag-
nosis of PTB was 81.6%, and specificity was 100%.
The PPV and NPV were 100% and 92.1%, respectively.
The sensitivity and specificity of AFB smear microscopy
were respectively 13.2% and 98.8%.
C O N C L U S I O N : The Xpert assay on bronchoscopy spec-
imens provided an accurate diagnosis of PTB in patients
who had a negative AFB smear or who could not pro-
duce sputum.
K E Y W O R D S : diagnosis; tuberculosis; bronchoscopy;
Xpert MTB/RIF assay

IN 2010, approximately 8.8 million people had ac-
tive tuberculosis (TB), and 1.4 million people died of
the disease. Because TB is the second most common
infectious cause of death worldwide, the World
Health Organization (WHO) has developed a global
TB control strategy to reduce the TB burden by
2015.1 To bring TB under control, rapid diagnosis
and immediate identification of drug resistance are
essential.
The WHO recently endorsed the Xpert® MTB/RIF
(Cepheid Inc, Sunnyvale, CA, USA) assay, an auto-
mated, single cartridge-based nucleic acid amplifica-
tion test that can simultaneously identify Mycobacte-
rium tuberculosis and detect rifampicin (RMP)
resistance within 2–3 h. The assay utilises real-time
polymerase chain reaction (rt-PCR) technology to
detect an 81-bp core region of the rpoB gene.2,3 The
sensitivity of the Xpert assay for the detection of
M. tuberculosis in sputum has been reported to be
>98% among smear-positive pulmonary TB (PTB)
patients and >70% among smear-negative patients.4,5
In addition, various clinical specimens other than
sputum have been tested using the Xpert assay in sus-
pected TB patients, and the results are generally
promising.6–8
Flexible bronchoscopy is regarded as a useful tool
in the diagnosis of PTB, as it obtains respiratory
specimens in patients with negative sputum acid-fast
bacilli (AFB) smear or those who cannot expectorate
sputum.9,10 However, the application of the Xpert as-
say in bronchial washing or bronchoalveolar lavage
(BAL) fluid has not yet been fully evaluated.
The aim of this study was to evaluate the accuracy
of the Xpert assay using samples obtained through
bronchoscopy (bronchial washing or BAL fluid) in pa-
tients with suspected PTB but who had a negative spu-
tum AFB smear or could not expectorate sputum.
MATERIAL AND METHODS
Study design
We retrospectively reviewed the records of all pa-
tients with suspected PTB among whom the Xpert
assay was performed using bronchial washing or

Correspondence to: Jae-Joon Yim, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
and Lung Institute, Seoul National University College of Medicine 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of
Korea. Tel: (+82) 2 2072 2059. Fax: (+82) 2 762 9662. e-mail: yimjj@snu.ac.kr
Article submitted 20 November 2012. Final version accepted 7 February 2013.
918 The International Journal of Tuberculosis and Lung Disease
BAL fluid between 1 September 2011 and 30 June
2012 at Seoul National University Hospital (Republic
of Korea). Xpert assay on bronchoscopy specimens
was requested in addition to AFB smear and myco-
bacterial culture for every patient who underwent
bronchoscopy for the diagnosis of PTB. Patients who
were diagnosed with sputum smear-positive PTB
before bronchoscopy or who had received anti-
tuberculosis medication for 2 weeks or more within
90 days before bronchoscopy were excluded. The
protocol of the study was approved by the Ethics
Review Committee of Seoul National University
Hospital (Seoul, Republic of Korea).
Bronchoscopy procedure
All bronchoscopy procedures were performed by
full-time faculty staff in the pulmonology division.
We used a flexible bronchoscope with a 5.9 mm di-
ameter (model BF-200 or BF-1T240, Olympus Opti-
cal Co, Tokyo, Japan). After inspecting all visible seg-
mental or bronchial trees, samples were collected
from the lung segment or subsegment that showed
abnormal lesions suggestive of active PTB on chest
computed tomography (CT). The choice between
bronchial washing and BAL was based on the judge-
ment of an individual clinician. Bronchial washing
fluid was obtained by instillation of 10 ml amounts
of normal saline and by aspiration until 20–30 ml re-
turned aspirate was collected in the trap bottle. For
BAL, 50–100 ml of normal saline were instilled and
aspirated from the lung segments involved. Half of the
specimens were sent for AFB smear and culture and
the other half were sent for Xpert MTB/RIF assay.
Acid-fast bacilli smear, mycobacterial culture
and Xpert MTB/RIF assay
All specimens for AFB smears and cultures were pre-
treated by decontamination with 4% weight/volume
sodium hydroxide (NaOH) and centrifugation at
3000× g for 20 min. The AFB smears were examined
after auramine-rhodamine staining. For culture, the
sediment was incubated in Ogawa medium (Shinyang
Chemical, Seoul, South Korea) for 8 weeks and in
BACTEC™ MGIT™ (BD, Sparks, MD, USA) for
6 weeks.
The Xpert assay was performed following the
manufacturer’s instructions. A total of 1.5 ml of
bronchial washing or BAL fluid were transferred into
the Xpert cartridge without initial decontamination
and then tested.
Diagnosis of pulmonary tuberculosis
A diagnosis of active PTB was based on the culture of
M. tuberculosis from a bronchoscopic specimen or
sputum. For secondary analysis, patients with positive
TB-PCR of lung tissue showing caseating granuloma
or patients with symptoms and radiographic findings
compatible with active PTB were considered to have
active PTB if their symptoms and radiographic le-
sions improved on anti-tuberculosis medication.
Analysis
The sensitivity, specificity, positive predictive value
(PPV) and negative predictive value (NPV) for the di-
agnosis of active PTB were calculated for AFB smear
and Xpert assay, and the 95% confidence intervals
(CIs) were estimated according to the exact binomial
distribution. McNemar’s test was used for compari-
son of sensitivities. All statistical analyses were per-
formed using Stata version 12 (Stata Corp, College
Station, TX, USA).
RESULTS
Characteristics of included patients
During the study period, 63 sputum smear-positive
TB cases were diagnosed in our hospital. Over the
same period, the Xpert assay using bronchial wash-
ing or BAL fluid was performed in 142 TB suspects.
Of these, eight patients were excluded because respi-
ratory diseases other than PTB were being investi-
gated through bronchoscopy. In addition, one patient
taking anti-tuberculosis medication at the time of
bronchoscopy and another for whom a positive AFB
sputum smear result was missed by the bronchosco-
pist were also excluded.
Of the 132 patients included in the final analysis,
50 (37.9%) were diagnosed as having active PTB, of
whom 38 were culture-positive, five were diagnosed
through tissue TB-PCR and pathological findings and
seven were diagnosed clinically, with evidence of im-
provement after treatment with anti-tuberculosis drugs
(Figure). Xpert assay using sputum was not requested
for all of the patients included in the study. The de-
mographic and clinical characteristics of the patients
with suspected PTB are shown in Table 1.
Diagnostic accuracy of acid-fast bacilli smear,
mycobacterial culture and Xpert MTB/RIF assay
The Xpert MTB/RIF assay using bronchoscopic spec-
imens showed positive results in 31 of 38 patients
with culture-positive PTB. The sensitivity of the Xpert
assay using bronchial washing or BAL fluid for the
diagnosis of PTB was 81.6% (95%CI 65.7–92.3),
and the specificity was 100% (95%CI 95.6–100.0),
while the PPV and NPV were 100% (95%CI 88.8–
100.0) and 92.1% (95%CI 84.5–96.8), respectively.
The sensitivity of AFB smear microscopy was 13.2%
(95%CI 4.4–28.1) and the specificity was 98.8%
(95%CI 93.4–100.0). The sensitivity of Xpert was
superior to that of AFB stain (McNemar’s test, P <
0.0001; Table 2).
When pathologically and clinically diagnosed PTB
in addition to culture-confirmed TB were used as a
combined reference standard, the sensitivity and
specificity of the Xpert MTB/RIF assay were 70%
 Xpert® MTB/RIF on bronchoscopy specimens 919

Figure Flow diagram of patients included for analysis. TB = tuberculosis;

AFB = acid-fast bacilli.

(95%CI 56.2–81.0) and 100% (95%CI 94.6–100.0), high frequency of TB, bronchoscopy should be per-
respectively. formed routinely for patients suspected of having
TB.16,17
Detection of rifampicin resistance Our study also confirms the role of bronchoscopy
Of the 35 patients with positive Xpert assay results, in the diagnosis of TB. First, it was possible to confirm
RMP resistance was identified in two. These results
as well as the absence of RMP resistance were con- Table 1 Demographic and clinical characteristics of
firmed by conventional drug susceptibility testing us- 132 patients with suspected PTB
ing the proportion method on 3% Ogawa medium. Characteristic n (%)
Age, years, median 54.0 (18–90)
Clinical characteristics of patients with Male 78 (59.1)
false-negative Xpert assay results Past history of TB treatment 28 (21.2)
Of the 50 patients with active PTB, 15 showed false- Co-morbidities
negative Xpert results. Compared with the patients Solid cancer on chemotherapy 7 (5.3)
with accurate results, those with false-negative results End-stage renal disease 5 (3.8)
Organ transplantation 3 (2.3)
were more likely to have TB lesions confined to a HIV/AIDS 1 (0.8)
single lobe (31.4% vs. 66.7%, P = 0.022) and to have Sputum AFB smear
clinically diagnosed TB without bacteriological con- No sputum—AFB stain could not be performed 40 (30.3)
firmation (33.3% vs. 5.7%, P = 0.01; Table 3). Negative 92 (69.7)
Final diagnosis
PTB 50 (37.9)
Bacteriologically confirmed 38 (28.8)
DISCUSSION Pathologically suggested 5 (3.8)
Clinically suggested 7 (5.3)
Bronchoscopy is well-known as a useful tool for the Bacterial pneumonia 25 (18.9)
diagnosis of PTB in patients who cannot produce Non-tuberculous mycobacterial lung disease 16 (12.1)
Lung cancer 12 (9.1)
sputum or those who are sputum AFB smear- Inactive fibrotic TB sequelae 3 (2.3)
negative.11–15 In one report, bronchoscopy specimens Other* 26 (19.7)
were considered superior to induced sputum for the * Interstitial lung diseases, 3; solitary pulmonary nodule, 4; pulmonary nod-
diagnosis of PTB.15 Because of the higher sensitivity ules, 3; chronic granuloma, 1; chronic eosinophilic pneumonia, 1; bronchi-
olitis, 5; pulmonary aspergillosis, 2; sarcoidosis, 1; undiagnosed, 6.
of tests using specimens obtained through bronchos- PTB = pulmonary tuberculosis; HIV = human immunodeficiency virus; AIDS =
copy, some experts recommend that in regions with a acquired immune-deficiency syndrome; AFB = acid-fast bacilli.
920 The International Journal of Tuberculosis and Lung Disease

Table 2 Diagnostic accuracy of AFB smear and Xpert® MTB/RIF assay using bronchoscopy specimens for the diagnosis of
clinical PTB
Positive Negative
Sensitivity* Specificity predictive value predictive value
Variable % (95%CI) % (95%CI) % (95%CI) % (95%CI)
Xpert MTB/RIF assay 81.6 (65.7–92.3) 100 (95.6–100.0) 100 (88.8–100.0) 92.1 (84.5–96.8)
AFB smear 13.2 (4.4–28.1) 98.8 (93.4–100.0) 83.3 (35.9–99.6) 71.1 (61.8–79.2)
* P < 0.0001 McNemar’s test.
AFB = acid-fast bacilli; PTB = pulmonary tuberculosis; CI = confidence interval.

the diagnosis of TB in only 12 of 38 patients after cul-
ture of bronchoscopy specimens; the Xpert assay on
bronchoscopy specimens yielded positive results in
35 of the 38 culture-confirmed TB patients. Given the
sensitivity of conventional TB-PCR using bronchos-
copy specimens,18,19 the 81.6% sensitivity of the Xpert
assay shown in our study using bronchoscopy speci-
mens suggests that Xpert could be more sensitive.
This study included 12 patients in whom TB was
pathologically or clinically indicated. Although M. tu-
berculosis was not cultured from bronchial speci-
mens, the Xpert assay yielded positive results in four
of the 12 patients. This suggests that the Xpert assay
could be more sensitive than conventional mycobac-
terial culture in some situations. The high sensitivity
of the Xpert MTB/RIF assay could be explained by
its analytical limit of detection, which is 131 colony-
forming units (cfu)/ml, and as few as 10 cfu/ml in
some samples.2,20
Of the 50 TB patients, 15 (30%) were Xpert false-
negative on bronchial specimens. Compared with the
TB patients with accurate results, those with false-
negative Xpert results had less extensive radiographic
lesions and were more frequently clinically diagnosed
without isolation of M. tuberculosis. As indicated in
a previous study,21 this suggests that a TB patient
with a false-negative Xpert result may have a lower
mycobacterial burden.
One of the important strengths of the Xpert assay
is its ability to detect the presence of resistance to
RMP. In the present study, only two patients had
RMP-resistant TB. Although the Xpert assay cor-
rectly diagnosed resistance on bronchial specimens,
the number of patients is not sufficient to conclude
that it is accurate in the diagnosis of RMP resistance.
The study had certain limitations. Most impor-
tantly, it was performed retrospectively, and studies
with a retrospective design are generally prone to bias.
The second limitation is that the cost-effectiveness
and turnaround time of the Xpert MTB/RIF assay
were not evaluated.
CONCLUSION
The Xpert MTB/RIF assay on bronchial washing or
BAL fluid provides an accurate diagnosis of PTB in
patients with AFB smear-negative sputum results or
who cannot produce sputum.

Table 3 Comparison of patients with accurate vs. false-negative Xpert TB/RIF assay results

Xpert-positive Xpert-negative
patients patients
(n = 35) (n = 15)
Characteristic n (%) n (%) P value*
Age, years, median [range] 46.9 [19–76] 54.53 [35–80] 0.15
Male 18 (51.4) 8 (53.3) 0.90
Past history of TB treatment 4 (11.4) 4 (26.7) 0.18
Co-morbidities
End-stage renal disease 0 1 (6.7) 0.13
Diabetes mellitus 3 (8.6) 2 (13.3) 0.61
Organ transplantation 1 (2.9) 0 0.51
Radiographic findings
Presence of cavity 12 (34.3) 4 (26.7) 0.60
Confined to one lobe 11 (31.4) 10 (66.7) 0.02
No sputum—AFB could not be performed 13 (37.1) 2 (13.3) 0.10
Diagnosis by
Culture 31 (91.4) 7 (46.7) 0.002
BAL or washing fluid only 12 (34.3) 2 (13.3) 0.13
Sputum only 4 (11.4) 3 (20) 0.43
Both 15 (42.9) 2 (13.3) 0.05
Pathology: TB PCR positive 2 (5.7) 3 (20) 0.13
Clinical examination 2 (5.7) 5 (33.3) 0.01

* Fisher’s exact test.

TB = tuberculosis; AFB = acid-fast bacilli; BAL = bronchoalveolar lavage; PCR = polymerase chain reaction.

Conflict of interest: none declared.
References
1 World Health Organization. WHO report 2011: global tuber-
culosis control. WHO/HTM/TB/2011.16. Geneva, Switzer-
land: WHO, 2011.
2 Helb D, Jones M, Story E, et al. Rapid detection of Mycobacte-
rium tuberculosis and rifampin resistance by use of on-demand,
near-patient technology. J Clin Microbiol 2010; 48: 229–237.
3 Blakemore R, Story E, Helb D, et al. Evaluation of the analyti-
cal performance of the Xpert MTB/RIF assay. J Clin Microbiol
2010; 48: 2495–2501.
4 Rachow A, Zumla A, Heinrich N, et al. Rapid and accurate
detection of Mycobacterium tuberculosis in sputum samples
by Cepheid Xpert MTB/RIF assay—a clinical validation study.
PloS ONE 2011; 6: e20458.
5 Boehme C C, Nabeta P, Hillemann D, et al. Rapid molecular
detection of tuberculosis and rifampin resistance. N Engl J
Med 2010; 363: 1005–1015.
6 Tortoli E, Russo C, Piersimoni C, et al. Clinical validation of
Xpert MTB/RIF for the diagnosis of extrapulmonary tubercu-
losis. Eur Respir J 2012; 40: 442– 447.
7 Raj A, Singh N, Mehta P K. Gene Xpert MTB/RIF assay: a new
hope for extrapulmonary tuberculosis. IOSR J Pharm 2012; 2:
83–89.
8 Marlowe E M, Novak-Weekley S M, Cumpio J, et al. Evalua-
tion of the Cepheid Xpert MTB/RIF assay for direct detection
of Mycobacterium tuberculosis complex in respiratory speci-
mens. J Clin Microbiol 2011; 49: 1621–1623.
9 Willcox P, Benatar S, Potgieter P. Use of the flexible fibreoptic
bronchoscope in diagnosis of sputum-negative pulmonary
tuberculosis. Thorax 1982; 37: 598–601.
10 Qiu P. The statistical evaluation of medical tests for classifica-
tion and prediction. J Am Stat Assoc 2005; 100: 705.
11 Jacomelli M, Silva P R A A, Rodrigues A J, Demarzo S E,
Seicento M, Figueiredo V R. Bronchoscopy for the diagnosis of
Xpert® MTB/RIF on bronchoscopy specimens 921
pulmonary tuberculosis in patients with negative sputum
smear microscopy results. J Bras Pneumol 2012; 38: 167–173.
12 Bachh A A, Gupta R, Haq I, Varudkar H G. Diagnosing sputum/
smear-negative pulmonary tuberculosis: does fibre-optic bron-
choscopy play a significant role? Lung India 2010; 27: 58.
13 Shin J A, Chang Y S, Kim T H, Kim H J, Ahn C M, Byun M K.
Fiberoptic bronchoscopy for the rapid diagnosis of smear-
negative pulmonary tuberculosis. BMC Infect Dis 2012; 12:
141.
14 Charoenratanakul S, Dejsomritrutai W, Chaiprasert A. Diag-
nostic role of fiberoptic bronchoscopy in suspected smear neg-
ative pulmonary tuberculosis. Respir Med 1995; 89: 621–623.
15 Iyer V N, Joshi A Y, Boyce T G, et al. Bronchoscopy in suspected
pulmonary TB with negative induced sputum smear and MTD®
Gen-probe testing. Respir Med 2011; 105: 1084–1090.
16 Ip M, Chau P, So S, Lam W. The value of routine bronchial
aspirate culture at fibreoptic bronchoscopy for the diagnosis of
tuberculosis. Tubercle 1989; 70: 281–285.
17 Sarkar S, Sharma T, Purohit S, Gupta M, Gupta P. The diagnos-
tic value of routine culture of bronchial washings in tuberculo-
sis. Br J Dis Chest 1982; 76: 358–360.
18 Tueller C, Chhajed P N, Buitrago-Tellez C, Frei R, Frey M,
Tamm M. Value of smear and PCR in bronchoalveolar lavage
fluid in culture positive pulmonary tuberculosis. Eur Respir J
2005; 26: 767–772.
19 Min J-W, Yoon H I, Park K U, Song J-H, Lee C-T, Lee J H.
Real-time polymerase chain reaction in bronchial aspirate for
rapid detection of sputum smear-negative tuberculosis. Int J
Tuberc Lung Dis 2010; 14: 852–858.
20 Rie A V, Page-Shipp L, Scott L, Sanne I, Stevens W. Xpert MTB/
RIF for point-of-care diagnosis of TB in high-HIV burden,
resource-limited countries: hype or hope? Expert Rev Mol
Diagn 2010; 10: 937–946.
21 Lawn S D, Kerkhoff A D, Vogt M, Ghebrekristos Y, Whitelaw
A, Wood R. Characteristics and early outcomes of patients
with Xpert MTB/RIF-negative pulmonary tuberculosis diag-
nosed during screening before antiretroviral therapy. Clin
Infect Dis 2012; 54: 1071–1079.

O B J E C T I F : Déterminer la précision du test Xpert®
MTB/RIF pour le diagnostic en utilisant des échantillons
obtenus par bronchoscopie chez les patients suspects de
tuberculose pulmonaire (TBP).
S C H É M A : Nous avons revu de manière rétrospective les
dossiers de patients suspects de TBP pour lesquels le test
Xpert avait été pratiqué à partir d’un échantillon prélevé
par bronchoscopie. On a calculé la sensibilité, la spéci-
ficité, la valeur prédictive positive (PPV) et la valeur
prédictive négative (NPV) pour le diagnostic d’une TBP
active d’une part pour les frottis à la recherche de bacilles
acido-résistants (AFB) et d’autre part pour le test Xpert
en utilisant comme standard de référence la culture de
Mycobacterium tuberculosis provenant des crachats ou
d’un échantillon prélevé sous bronchoscopie.
O B J E T I V O : Determinar la exactitud diagnóstica de la
prueba Xpert® MTB/RIF en muestras obtenidas por
fibrobroncoscopia en pacientes con presunción clínica
de tuberculosis pulmonar (TBP).
M É T O D O S : Se estudiaron de manera retrospectiva los
expedientes clínicos de pacientes con presunción de TBP,
en quienes se practicó la prueba Xpert en una muestra
obtenida por fibrobroncoscopia. Se calcularon la sensi-
bilidad, la especificidad, el valor diagnóstico de un
resultado positivo (PPV) y el valor diagnóstico de un
resultado negativo (NPV) en el diagnóstico de TBP activa
para la baciloscopia con coloración acidorresistente y
para la prueba Xpert tomando como criterio de refe-
rencia el cultivo de Mycobacterium tuberculosis a partir
Xpert® MTB/RIF on bronchoscopy specimens i
RÉSUMÉ
R É S U LTAT S : Au total, l’analyse finale a porté sur
132 patients. Parmi ceux-ci, il y a eu 38 cas de TBP
confirmée par culture. La sensibilité du test Xpert
utilisant le lavage bronchique ou le liquide broncho-
alvéolaire pour le diagnostic de la TBP a été de 81,6%
et sa spécificité de 100%. La PPV et la NPV ont été
respectivement de 100% et de 92,1%. La sensibilité et la
spécificité de la bacilloscopie des frottis ont été respec-
tivement de 13,2% et de 98,8%.
C O N C L U S I O N : Le test Xpert MTB/RIF à partir d’un
échantillon d’origine bronchoscopique garantit un di-
agnostic précis de la TBP chez les patients à bacilloscopie
négative des frottis ou qui ne réussissent pas à fournir
des crachats.
RESUMEN
de una muestra de esputo o una muestra obtenida por
fibrobroncoscopia.
R E S U LTA D O S : Se incluyeron 132 pacientes en el análisis
final y en 38 casos se confirmó el diagnóstico de TBP.
La prueba Xpert en muestras obtenidas por aspirado
bronquial o lavado broncoalveolar en el diagnóstico de
TBP ofreció una sensibilidad de 81,6% y una especifi-
cidad de 100%. El PPV fue 100% y el NPV fue 92,1%.
La sensibilidad de la baciloscopia fue 13,2% y la especifi-
cidad fue 98,8%.
C O N C L U S I Ó N : La prueba Xpert practicada en muestras
obtenidas por fibrobroncoscopia ofrece un diagnóstico
exacto de TBP en pacientes con una baciloscopia nega-
tiva del esputo o que no pueden producir esputo.