Percutaneous Transthoracic Biopsy for Thoracic Lesions: Comparison of the Utility of Fine Needle Aspiration (FNA), Percutaneous Cutting Needle Biopsy (PCNB) and Combination of Both Methods

PURPOSE: To assess the diagnostic role of FNA, PCNB, and a combination of both methods in patients who underwent percutaneous transthoracic biopsy for a malignant or benign intrathoracic lesion. MATERIALS AND METHODS: We retrospectively reviewed the findings of 213 patients with an intrathoracic mass or consolidation who underwent FNA (Group A, n=98), PCNB (Group B, n=31) or a combination of both methods (Group C, n=84). Under fluoroscopic guidance, diagnoses were based on the findings of surgery, biopsy at another site or clinical and radiologic follow-up. In the differential diagnosis of benign and malignant disease, and in the diagnosis of small-cell lung cancer, pulmonary tuberculosis, non-tuberculous infectious disease and benign mass, sensitivity, specificity and accuracy were statistically analysed in each group. RESULTS: Among 213 patients, lesions were malignant in 134 and benign in 79. In group A, sensitivity and specificity were 90.1% and 100% for malignant lesions, and 91.5% and 90.1% for benign, while in group B, the corresponding findings were 90.4% and 100%, and 90.0% and 90.1%. In group C, corresponding rates of 95.1% and 100% (p<0.05) and 100% and 92% (p<0.05) were recorded. In group C, accuracy and sensitivity were higher than in group A or (p<0.05). Post-procedural pneumothorax occurred in 15.3% of group A, 13.3% of group B, and 20.6% of group C, while hemoptysis was found in 7.1% of group A, 13.3% group B, and 2.9% of group C. Among the three groups, the complication rate showed no statistically significant variation (p<0.05). In the specific diagnosis of small-cell lung cancer, the sensitivity and specificity of FNA and PCNB were, respectively, 100% and 98.5%, and 90.0% and 98.0% (p<0.05) ; for tuberculosis, the corresponding figures were 35.0% and 100%, and 20.0% and 97.2 (p<0.05). FNA was better in the diagnosis of non-tuberculous infectious disease, while PCNB was better in the specific diagnosis of benign masses, without statistical significance. Conclusion: FNA is superior to PCNB in the diagnosis of tuberculosis and the differentiation of small cell lung cancer, and is thus the indicated initial approach for the majority of patients who are to undergo transthoracic bigosy. A combination of FNA and PCNB can provide more accurate differentiation between malignant and benign thoracic disease, without increasing the complication rate, than can one method used alone.

Traumatic Facial Nerve Palsy: CT Patterns of Facial Nerve Canal Fracture and Correlation with Clinical Severity

PURPOSE: To analyse the patterns of facial nerve canal injury seen at temporal bone computed tomography (CT) in patients with traumatic facial nerve palsy and to correlate these with clinical manifestations and outcome. MATERIALS AND METHODS: Thirty cases of temporal bone CT in 29 patients with traumatic facial nerve palsy were analyzed with regard to the patterns of facial nerve canal involvement. The patterns were correlated with clinical grade, the electroneurographic (ENoG) findings, and clinical outcome. For clinical grading, the House-Brackmann scale was used, as follows: grade I-IV, partial palsy group; grade V-VI, complete palsy group. The electroneuronographic findings were categorized as mild to moderate (below 90%) or severe (90% and over) degeneration. RESULTS: In 25 cases, the bony wall of the facial nerve canals was involved directly (direct finding): discontinuity of the bony wall was onted in 22 cases, bony spicules in ten, and bony wall displacement in five. Indirect findings were canal widening in nine cases and adjacent bone fracture in two. In one case, there were no direct or indirect findings. All cases in which there was complete palsy (n=8) showed one or more direct findings including spicules in six, while in the incomplete palsy group (n=22), 17 cases showed direct findings. In the severe degeneration group (n=13), on ENog, 12 cases demonstrated direct findings, including spicules in nine cases. In 24 patients, symptoms of facial palsy showed improvement at follow up evaluation. Four of the five patients in whom symptoms did not improve had spicules. Among ten patients with spicules, five underwent surgery and symptoms improved in four of these; among the five patients not operated on, symptoms did not improve in three. CONCLUSION: In most patients with facial palsy after temporal bone injury, temporal bone CT revealed direct or indirect facial nerve canal involvement, and in complete palsy or severe degeneration groups, there were direct findings in most cases. We believe that meticulous analysis and symptom correlation of the fracture patterns seen in facial nerve canal injury in patients with traumatic facial nerve palsy is helpful for treatment planning and prognosis.

The Clinical study of Lung Cancer in Patients Younger than 40 Years of Age / 결핵

BACKGROUND: Bronchogenic carcinoma is generally considered as a disease that predominantly affects middle-aged and elderly men. A small percentage of patients with lung cancer are diagnosed in the third or fourth decade of life or earlier. The current study was performed to review the clinical characteristics of bronchogenic carcinoma in patients younger than 40 years of age at Chungnam National University Hospital. METHOD: To determine the clinicopathologic characteristics including survival rates of lung cancer patients younger than 40 years of age and to compare them with those of patients older than 40 years of age at diagnosis, data of 905 patients diagnosed as lung cancer from January 1990 to March 1997 were analyzed. RESULT: Twenty-three of 805 patients(2.5%) belonged to the young age group (less than 40 years). Male to female ratios of young age group and control group were 2.8 : 1 and 5.3 : 1, respectively. The mean duration of symptoms from onset to the definite diagnosis was 3.2 months in the young age group. The most common initial symptoms in the young age group were cough(52.2%) and dyspnea(43.5%). Adenocarcinoma(43.5%) was more frequent in the young age group than in the control group(20.1%). Stage III and IV(70%) tumors were more frequent in the young age group than in the control group(52.3%). Distant metastasis rae of the young age group(56.6%) was higher than that of the control group(22.3%). CONCLUSION: The predominance of adenocarcinoma, the lower male-female ratio, and the high incidence of advanced stage tumor at diagnosis are the characteristics of lung cancer in patients younger than 40 years of age.

A Clinical Study on Tuberculous Cervical Lymphadenitis / 대한내과학회지

OBJECTIVES: Tuberculous cervical lymphadenitis is one of the common cause of cervical mass in young adult in Korea. Sometimes it appears to be difficult in defining the role of surgery and duration of antituberculous treatment. To clarify the duration of medical treatment and to define the cause of prolonged treatment duration METHODS: we analyzed the clinical data of 62 patients with tuberculous cervical lymphadenitis diagnosed at the Chungnam National University Hospital from Jan. 1994 to July 1996 and all patients were divided into two groups (standard and prolonged) by treatment duration. RESULTS: The most prevalent age group was 20 to 39 years old (67%) and male to female ratio was 1:2.6. The most common physical finding was painless swelling on neck, standard group was 52%, prolonged group was 42%. The average size of lymph node was 2.7cm and 3.2cm, respectively (p<0.05). In prolonged group, incidence of associated pulmonary tuberculosis and previous antituberculous treatment history were higher than that in standard group (27%, 35% respectively). The most common affected site was right side of neck , whereas 19% of prolonged regimen group were involved in both side of neck. Bacteriological study from node aspirates showed relatively higher positivity in prolonged group (27%) than in standarded group (5%). The causes of prolonged treatment were increased mass(27%) or remnant mass(23%) and the develoment of new node formation and existing nodes after completion of treatment were found in both groups(10% of standard group , 19% of prolonged group). CONCLUSION: A new, prospective trial for proper regimens or duration of antituberculosis treatment is strongly needed.