The Role of Transbronchial Needle Aspiration for Diagnosis of Bronchogenic Carcinoma / 대한암학회지

PURPOSE: Transbronchial needle aspiration (TBNA) has been used for the diagnosis and staging of bronchogenic carcinoma through the flexible bronchoscope. The aim of this study was to investigate the diagnostic role of TBNA for bronchogenic carcinoma. MATERIALS AND METHODS: TBNA was performed in 34 patients with suspected bron- chogenic carcinoma. We analyzed diagnostic rate of TBNA m 28 patients who were ulti- mately diagnosed as bronchogenic carcinoma. RESULTS: In 12 of 28 patients, TBNA was performed for endobronchial lesions with a type of infiltration, nodular infiltration or compression. The diagnostic rate was 75%. Addition of TBNA to bronchial washing, brush, and biopsy increased the diagnostic rate from 58% to 80%. In 16 patients with peripheral tumor and mediastinal lymphadenopathy, TBNA was performed for mediastinal lymph nodes. The diagnostic rate was 62.5%, and was positively correlated with the size of lymph nodes. There was no significant complications related to TBNA. CONCLUSION: TBNA was a safe and effective procedure for the diagnosis of bronchogenic carcinoma in selected patients.

Clinical Analysis of Spontaneous Pneumothorax / 결핵

BACKGROUND: The aim of this study was to investigate etiologic factor, treatment, prognosis of spontaneous pneumothorax(SP). MATERIAL AND METHODS: The medical records of 225 cases of SP experienced at Kyungpook University Hospital from Jan. 1996 to Dec. 1997 were retrospectively analyzed. RESULTS: 1. The patients were 128 primary SP and 97 secondary SP. The mean age was 30 +/- 15.5 years in primary SP and 51 +/- 7.4 years in secondary SP. 2. The ratio of male to female was 8 : 1 in primary SP and 5.5 : 1 in secondary SP. Smoker was more common in secondary SP (71.1%) than primary SP(34.4%). About 70% of patients with primary and secondary SP was underweighted. 3. The previous history of SP was present in 28.9% and 25.8% of primary and secondary SP, respectively. 4. The main underlying lung diseases in secondary SP were inactive tuberculosis(68%), active tuberculosis(12.4%) and COPD(11.3%). 5. Tube thoracotomy was performed in 96.8% and 97.9% of primary and secondary SP, respectively. The duration of chest tube insertion was longer in secondary SP (18.2 +/- 19.59 days) than primary SP (7.5 +/- 6.57 days). 6. The open thoracotomy were performed in 22.7% and 10.3% of primary and secondary SP, respectively. The most common indication of open thoracotomy was recurrence on primary SP and persistent air leak in secondary SP. 7. During following-up of 17 +/- 7.8 months, the recurrence rate on patients with conservative treatment was 16.5% and 11.8% of primary and secondary SP, respectively. The recurrence was most common within 1 month after discharge. CONCLUSION: Greater attention and research about SP are necessary for more efficient patient care.

Changing Trends of Clinical Aspects in Lung Cancer from 1988 to 1996 - Hostipal Based Study / 대한암학회지

PURPOSE: Lung cancer is now one of the most frequently diagnosed cancers in the world and its incidence has been increasing also in Korea. In several recent studies, the indidence of adenocarcinoma and female/male ratio have been reported to be increasing. The aim of this study is to investigate the changing trends in sex and age distribution, the histologic type and location (peripheral or central) of tumors in lung cancer. MATERIALS AND METHODS: We performed the retrospective review of histopathology and clinical information of 1409 patients diagnosed as baving primary lung cancer, except non-epithelial tumors and undetermined histologic types, at Kyungpook National University Hospital from January 1988 to December 1996. RESULTS: Male to female ratio was 4.6; 1. The peak incidence of age group was 7th decade (40.3%) with mean age of 61.5. Percentage of smokers in patients with lung cancer was 84.3%. Total number of patients with lung cancer has increased recently. However, the annual female/male ratio was nearly constant during the study period. Peripheral tumors, which were found in 20.6% of patients with lung cancer in 1988, increased to 33.5% in 1996 and this trend was more prominent in squamous cell carcinoma than in adenocarcinoma. Squamous cell carcinoma was the most common histologic type (62.0%), followed by adenocarcinoma (19.2%), small cell carcinoma (14.2%), large cell carcinoma (4.6%) in order. There was a predominance of squamous cell carcinoma (67.9%) in males and of adenocarcinoma (46.6%) in females. There has been a significant shift in the histology pattern with an increase in the percentage of adenocarcinoma. The incidence of adenocarcinoma was more than doubled from 7.5% in 1988 to 25.8% in 1996. CONCLUSION: These findings suggest that the epidemiology of lung cancer is changing.

Bronchial Brushing and Bronchial Washing for Diagnosis of Central Lung Cancer / 결핵

BACKGROUND: Forceps biopsy, bronchial brushing, and bronchial washing are used in conjuction with bronchoscopy to provide specimens for histologic and cytologic analysis in patients with suspected lung cancer. This study was performed to evaluate how many times brushing should be done and how much fluid should be used during bronchial washing for increasing diagnostic yield, and to evaluate which combination of these procedures gives the highest diagnostic yield. METHODS: Forty patients, with suspected lung cancer, who had bronchoscopically visible lesions were enrolled in this prospective study. During one bronchoscopic examination four forceps biopsies, four bronchial brushings, and bronchial washing were done in all patients. The patients were divided into four groups by the amount of normal saline used for bronchial washing; group I, 10 ml; group II, 20ml; group III 30ml, and group IV, 40ml. We analyzed the results in 36 patients confirmed as lung cancer. RESULTS: The diagnostic sensitivity of bronchial washing before and after forceps biopsy and bronchial brushing were 36% and 28%, respectively. The cumulative diagnostic sensitivity of bronchial washing were 47% and significantly higher than that of bronchial washing before or after forceps biopsy and bronchial brushing (p < 0.05). The diagnostic sensitivity of bronchial washing with saline of 30ml was significantly higher than that of bronchial washing with saline of 10ml or 20ml (p < 0.05). The diagnostic sensitivity of the first brushing was 75%, the second brushing 78%, the third brushing 83%, and the fourth brushing 67%. With repeated brushing up to three times, the diagnostic sensitivity increased to 92% (p<0.05). However, inclusion of the fourth brushing did not give a further increase of the diagnostic sensitivity. The diagnostic sensitivity of forceps biopsy was 86%. The diagnostic sensitivities of forceps biopsy by the type of bronchial lesion were as follows: tumor, 88%; infliltration, 67%; infiltration with nodularity, 80%; and collapse, 100%. The combination of forceps biopsy and bronchial washing gave a diagnostic sensitivity of 89%. The diagnostic sensitivity of combining forceps biopsy with bronchial brushing was 97%. Addition of bronchial washing did not increase the diagnostic yield over forceps biopsy and bronchial brushing. CONCLUSION: In patients with central lung cancer, forceps biopsies and repeated brushings up to three times should be done for maximal diagnostic yield.

Effect of Immune System on Retrovirus-Mediated Herpes Simplex Virus Thymidine Kinase Gene Therapy / 결핵

BACKGROUND: The impact of the immune response on cancer gene therapy using viral vectors to deliver a "suicide gene" is currently unclear. A vigrous immune response targeted at viral proteins or transgene may enhance the efficacy of tumor destruction and even augment responses to tumor antigens. These responses may involve the release of cytokines and stimulation of tumor specific cytotoxic T-lymphocytes that enhance therapeutic efficacy. On the other hand, a vigorous rapid cellular immune response may destroy cells expressing the therapeutic gene and attenuate the response to therapy. Furthermore, development of neutralizing antibody responses may prevent readministration of virus, a potentially significant limitation. Evaluating the significance of these limitations in animal models and developing solutions are therefore of obvious importance. METHODS: After retroviral transduction of mouse mesothelioma cell line(AB12) with Herpes Simplex Virus thymidine kinase (HSVtk) gene in vitro, subcutaneous flank tumors were established. To study the effect of intact immune system on efficacy of tumor erradication, the ability of the HSVtk/ganciclovir system to inhibit tumor growth was compared among normal Balb/c mice, immunodeficient Balb/c-nude and SCID mice, and Balb/c mice immunosuppressed with cyclosporin. RESULTS: Ganciclovir treatment resulted in greater inhibition of tumor growth in Balb/c mice compared with immunodeficient Balb/c-nude mice and SCID mice(in immunodeficient mice, there were no growth inhibition by ganciclovir treatment). Ganciclovir treatment resulted in greater inhibition of tumor growth in non-cyclosporin (CSA) treated Balb/c mice compared with CSA treated Balb/c mice. On day 8, mean ganciclovir-treated tumor volume were 65% of control tumor volume in Balb/c mice versus 77% control tumor volume in CSA-treated Balb/c mice. This effect was still evident during therapy (day 11 and 13). On day 13, non-CSA treated tumor volume was 35% of control tumor volume versus 60% of control tumor volume in CSA treated Balb/c mice. Duration of expression of HSVtk was not affected by the immunosuppression with CSA. CONCLUSION: These results indicate that the immune responses against retrovirally transduced cells enhance the efficacy of the HSVtk/ganciclovir system. These findings have important implications for clinical trials using currently available retrovirus vectors as well as for future vector design.

Prognostic Value of TNM Staging in Small Cell Lung Cancer / 결핵

BACKGROUND: Accurate staging is important to determine treatment modalities and to predict prognosis for the patients with lung cancer. The simple two-stage system of the Veteran's Administration Lung Cancer study Group has been used for staging of small cell lung cancer(SCLC) because treatment usually consists of chemotherapy with or without radiotherapy. However, this system does not accurately reflect segregation of patients into homogenous prognostic groups. Therefore, a variety of new staging system have been proposed as more intensive treatments including either intensive radiotherapy or surgery enter clinical trials. We evaluate the prognostic importance of TNM staging, which has the advantage of providing a uniform detailed classification of tumor spread, in patients with SCLC. METHODS: The medical records of 166 patients diagnosed with SCLC between January 1989 and December 1996 were reviewed retrospectively. The influence of TNM stage on survival was analyzed in 147 patients, among 166 patients, who had complete TNM staging data. RESULTS: Three patients were classified in stage l /ll, 15 in stage llla, 78 in stage lllb and 48 in stage lV. Survival rate at 1 and 2 years for these patients were as follows stage l/ll, 75% and 37.5% ; stage llla, 46.7% and 25.0% ; stage lllb, 34.3% and 11.3% ; and stage lV, 2.6% and 0%. The 2-year survival rates for 84 patients who received chemotherapy(more than 2 cycles) with or without radiotherapy were as follows stage l/ll, 37.5% ; stage lll, 31.3% ; stage lllb 13.5% ; and stage lV 0%. Overall outcome according to TNM staging was significantly different whether or not received treatment. However, there was no significant difference between stage llla and stage lllb though median survival and 2-year survial rate were higher in stage llla than stage lllb. CONCLUSION: These results suggest that the TNM staging system may be helpful for predicting the prognosis of patients with SCLC.