Diagnostic Value of Transbronchial Lung Biopsy: Including Diagnostic Yield According to Tumor-bronchus Relationship / 결핵

BACKGROUND: Transbronchial lung biopsy (TBLB) is a relatively simple and convenient procedure to obtain lung tissue in from a patient, with with diffuse or localized lesion on chest radiographs, whose disease cannot be diagnosed through routine tests. The authors tried to evaluate the diagnostic value of TBLB, especially, the concordance between CT scan and TBLB with respect to the location of the lesion, and and diagnostic yield according to tumor-bronchus relationship. METHOD: We reviewed the medical records, plain chest films, and chest CT scans of 278 patients who underwent TBLB at Kyungpook National University Hospital between January 1996 and June 1998. RESULTS: One hundred and sixteen (41.7 %) patients were diagnosed by TBLB. Diagnostic yield of TBLB in of malignant tumor tumors tended to be higher than that of benign disease diseases (64.7 % versus 53.9 %, p=0.09). Of primary lung cancers, TBLB was more diagnostic in adenocarcinoma and small-cell carcinoma than the rest other cell types (p<0.01) and, of benign diseases, more diagnostic in tuberculosis than in non-tuberculous diseases (p<0.05). According to the location of tumor, there was There was no significant difference in the diagnostic rate according to the location of the tumor. The diagnostic rate tended to increase with the size of tumor (p=0.06). In benign disease, there There was no difference in the The diagnostic rate of TBLB did not differ according to the pattern of lesion in benign diseases(.) but in malignant disease, However, in malignant diseases TBLB was more diagnostic in diffuse/multiple nodular lesion lesions than in localized lesion lesions (p<0.05). According to the tumor-bronchus relationship, TBLB was more diagnostic in type I/II groups than the rest in other types. CT scan and TBLB showed a strong correlation with respect to the localization of the lesion (gamma=0.994, p<0.01). CONCLUSION: The above results showed show that TBLB is useful in the diagnosis of lung disease. CT scan and TBLB showed a strong correlation in deciding in determining the location of the lesion. Diagnostic yield of TBLB is higher in the lesion lesions with 'bronchus sign' (type I and II). It is anticipated that (delete) TBLB and other diagnostic methods such as transthoracic needle aspiration have complementary role in diagnosing lung disease. are expected to complement one another in the diagnosis of lung diseases.

Role of Invasive Procedures in the Diagnosis and Management of Pulmonary Infiltrates in Patients with Leukemia / 결핵

BACKGROUND: Pulmonary infiltrate is a frequent cause of morbidity and mortality in patients with leukemia. It is often hard to obtain a reliable diagnosis by clinical and radiologic findings alone. The aim of this study was to evaluate diagnostic and therapeutic benefits of invasive procedures as for for new lung infiltrates in leukemia. METHODS: Patients with leukemia who developed new lung infiltrates from December 1994 to March 1999 were included in this study. These patients were classified into the empirical group who received empirical therapy only and into the invasive group who underwent bronchoscopy or surgical lung biopsy for the diagnostic purpose of new lung infiltrates. Retrospective A retroactive chart review was done to search for find the etiologies of new lung infiltrates, the yield of invasive procedures, outcome as well as predicting factors for survival of patients. RESULTS: 1) One hundred-two episodes of new lung infiltrates developed in 90 patients with leukemia. Invasive procedure was performed in 44 episodes while 58 episodes were treated with empirical therapy only. 2) Invasive procedures yielded a specific diagnosis in 72.7%(32/44)(,) of which 78.1% had infectious etiology. Therapeutic plan was changed in 52.3%(23/44) of patients after invasive procedures. None of them showed procedure-related mortality. 3) Overall The overall survival rate was 62.7%(64/102). Survival rate in the invasive group(79.5%) was significantly better than that in the empirical group (50.0%) (p=0.002). 4) On multivariate analysis, Upon multivariate analysis, the performance of invasive procedures, no need for mechanical ventilation and achievement of complete remission of leukemia after induction chemotherapy were the independent factors predicting predicting factors for survival in patients with leukemia and new lung infiltrates. CONCLUSION: Bronchoscopy and surgical lung biopsy are useful in the diagnosis of new lung infiltrates in patients with leukemia. However, survival benefits of invasive procedures should be considered together with disease status of leukemia and severity of respiratory compromise.