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1.
Cancer Research and Treatment ; : 77-86, 2021.
Article in English | WPRIM | ID: wpr-874372

ABSTRACT

Purpose@#Immune checkpoint inhibitors (ICI) and targeted small-molecule drugs are mainstay elements of lung cancer chemotherapy. However, they are associated with development of pneumonitis, a rare, but potentially life-threatening event. We analyzed lung cancer patients treated with ICI to evaluate the effect of sequential therapeutic administration on the incidence of pneumonitis. @*Materials and Methods@#In this retrospective study, 242 patients were included. Serial radiologic findings taken during and immediately after ICI treatment were reviewed. Factors that increased pneumonitis and the relationship between peri-ICI chemotherapy and the development of pneumonitis were evaluated. @*Results@#Pneumonitis developed in 23 patients (9.5%); severe pneumonitis (grade ≥ 3) occurred in 13 of 23 patients (56%); pneumonitis-related death occurred in six. High-dose thoracic radiation (≥ 6,000 cGy) revealed a tendency toward high risk of pneumonitis (odds ratio, 2.642; 95% confidence interval, 0.932 to 7.490; p=0.068). Among 149 patients followed for ≥ 8 weeks after the final ICI dose, more patients who received targeted agents within 8-weeks post-ICI experienced pneumonitis (3/16, 18.8%) compared with patients who received cytotoxic agents (4/54, 7.4%) or no chemotherapy (4/79, 5.1%) (p=0.162). Targeted therapy was associated with earlier-onset pneumonitis than treatment with cytotoxic agents (35 vs. 62 days post-ICI, p=0.007); the resulting pneumonitis was more severe (grade ≥ 3, 100% vs. 0%, p=0.031). @*Conclusion@#Sequential administration of small-molecule targeted agents immediately after ICI may increase the risk of severe pneumonitis. The sequence of chemotherapy regimens that include ICI and targeted agents should be carefully planned to reduce the risk of pneumonitis in lung cancer patients.

2.
Journal of the Korean Radiological Society ; : 826-836, 2019.
Article in Korean | WPRIM | ID: wpr-916847

ABSTRACT

Before the implementation of lung cancer screening as a national cancer screening program, the Korean Lung Cancer Screening Project was performed to evaluate its effectiveness and feasibility. A national lung cancer screening program with low-dose CT (LDCT) will begin from the second half of 2019. LDCT should be performed in high-risk subjects, aged 54–74 years, with a smoking history of 30 pack years or more. The use of multi-detector CT with a minimum of 16 channels is recommended, and LDCT scanning should be performed with the maximum CTDIvol radiation dose of 3 mGy in standard-sized subjects. The results of LDCT should be reported using the Lung CT Screening Reporting and Data System by diagnostic radiologists educated in specified programs. Radiologists play an important role in lung cancer screening. Quality control and reporting of LDCT is mandatory, and continued education is necessary. Cessation of smoking is the most important in lung cancer screening.

3.
Journal of the Korean Radiological Society ; : 837-848, 2019.
Article in Korean | WPRIM | ID: wpr-916846

ABSTRACT

A low-dose chest CT is performed for early detection of lung cancer, but the CT scan frequently shows several incidental abnormalities. Identification of the incidental findings may enable early detection of diseases other than lung cancer, thereby improving the survival of the individual undergoing screening. However, insignificant incidental abnormalities may cause unnecessary additional examination and costs. It is crucial for radiologists to appropriately comprehend and report significant incidental abnormalities other than lung cancer for successful implementation of the national lung cancer screening program in Korea.

4.
Journal of the Korean Radiological Society ; : 860-871, 2019.
Article in Korean | WPRIM | ID: wpr-916844

ABSTRACT

Lung cancer screening in high-risk subjects using low-dose CT can reduce mortality by 20%. Current evidence suggests that the development of a risk prediction model for lung cancer is one of the major advances in lung cancer screening. Herein, we review the technical requirements for evaluating different risk prediction models. Moreover, we describe the major lung cancer risk prediction models reported, and the results of lung cancer screening using these models.

5.
Cancer Research and Treatment ; : 1285-1294, 2019.
Article in English | WPRIM | ID: wpr-763231

ABSTRACT

PURPOSE: To reduce lung cancer mortality, lung cancer screening was recommended using low-dose computed tomography (LDCT) to high-risk population. A protocol for multicenter lung cancer screening pilot project was developed to evaluate the effectiveness and feasibility of lung cancer screening to implement National Cancer Screening Program in Korea. MATERIALS AND METHODS: Multidisciplinary expert committee was comprised to develop a standardized protocol for Korean Lung Cancer Screening Project (K-LUCAS). K-LUCAS is a population-based single arm trial that targets high-risk population aged 55-74 years with at least 30 pack-year smoking history. LDCT results are reported by Lung-RADS suggested by American Radiology Society. Network-based system using computer-aided detection program is prepared to assist reducing diagnostic errors. Smoking cessation counselling is provided to all currently smoking participants. A small pilot test was conducted to check the feasibility and compliance of the protocols for K-LUCAS. RESULTS: In pilot test, 256 were participated. The average age of participants was 63.2 years and only three participants (1.2%) were female. The participants had a smoking history of 40.5 pack-year on average and 53.9% were current smokers. Among them, 86.3% had willing to participate in lung cancer screening again. The average willingness to quit smoking among current smokers was 12.7% higher than before screening. In Lung-RADS reports, 10 (3.9%) were grade 3 and nine (3.5%) were grade 4. One participant was diagnosed as lung cancer. CONCLUSION: The protocol developed by this study is assessed to be feasible to perform K-LUCAS in multicenter nationwide scale.


Subject(s)
Female , Humans , Arm , Compliance , Diagnostic Errors , Early Detection of Cancer , Korea , Lung Neoplasms , Lung , Mass Screening , Mortality , Pilot Projects , Smoke , Smoking , Smoking Cessation
6.
Cancer Research and Treatment ; : 1488-1499, 2019.
Article in English | WPRIM | ID: wpr-763212

ABSTRACT

PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is widely used for the diagnosis and staging of lung cancer. However, evidence of its usefulness for re-biopsy in treated lung cancer, especially according to the previous treatment, is limited. We evaluated the role of EBUS-TBNA for re-biopsy and its diagnostic values in patients with different treatment histories. MATERIALS AND METHODS: We reviewed the medical records of patients who underwent EBUS-TBNA for re-biopsy of suspicious recurrent or progressive lesions between January 2006 and December 2016 at the National Cancer Center in South Korea. Patients were categorized into three groups based on the previous treatment modalities: surgery, radiation, and palliation. RESULTS: Among the 367 patients (surgery, n=192; radiation, n=40; palliation, n=135) who underwent EBUS-TBNA for re-biopsy, the overall sensitivity, negative predictive value (NPV), and diagnostic accuracy of EBUS-TBNA in detecting malignancy were 95.6%, 82.7%, and 96.3%, respectively. The sensitivity was lower in the radiation group (83.3%) when compared with the surgery (95.7%, p=0.042) and palliation (97.7%, p=0.012) groups. The NPV was lower in the palliation group (50.0%) than in the surgery group (88.5%, p=0.042). The sample adequacy of EBUS-TBNA specimens was lower in the radiation group (80.3%) than in the surgery (95.4%, p < 0.001) or palliation (97.8%, p < 0.001) groups. EGFR mutation analysis was feasible in 94.6% of the 92 cases, in which mutation analysis was requested. There were no major complications. Minor complications were reported in 12 patients (3.3%). CONCLUSION: EBUS-TBNA showed high diagnostic values and high suitability for EGFR mutation analysis with regard to re-biopsy in patients with previously treated lung cancer. The sensitivity was lower in the radiation group and NPV was lower in the palliation group. The complication rate was low.


Subject(s)
Humans , Biopsy , Diagnosis , Korea , Lung Neoplasms , Lung , Medical Records , Needles
7.
Korean Journal of Radiology ; : 1179-1186, 2018.
Article in English | WPRIM | ID: wpr-718932

ABSTRACT

OBJECTIVE: The purposes of this study were to evaluate size-specific dose estimate (SSDE) of low-dose CT (LDCT) in the Korean Lung Cancer Screening (K-LUCAS) project and to determine whether CT protocols from Western countries are appropriate for lung cancer screening in Korea. MATERIALS AND METHODS: For participants (n = 256, four institutions) of K-LUCAS pilot study, volume CT dose index (CTDI(vol)) using a 32-cm diameter reference phantom was compared with SSDE, which was recalculated from CTDI(vol) using size-dependent conversion factor (f-size) based on the body size, as described in the American Association of Physicists in Medicine Report 204. This comparison was subsequently assessed by body mass index (BMI) levels (underweight/normal vs. overweight/obese), and automatic exposure control (AEC) adaptation (yes/no). RESULTS: Size-specific dose estimate was higher than CTDI(vol) (2.22 ± 0.75 mGy vs. 1.67 ± 0.60 mGy, p < 0.001), since the f-size was larger than 1.0 for all participants. The ratio of SSDE to CTDI(vol) was higher in lower BMI groups; 1.26, 1.37, 1.43, and 1.53 in the obese (n = 103), overweight (n = 70), normal (n = 75), and underweight (n = 4), respectively. The ratio of SSDE to CTDI(vol) was greater in standard-sized participants than in large-sized participants independent of AEC adaptation; with AEC, SSDE/CTDI(vol) in large- vs. standard-sized participants: 1.30 ± 0.08 vs. 1.44 ± 0.08 (p < 0.001) and without AEC, 1.32 ± 0.08 vs. 1.42 ± 0.06 (p < 0.001). CONCLUSION: Volume CT dose index based on a reference phantom underestimates radiation exposure of LDCT in standard-sized Korean participants. The optimal radiation dose limit needs to be verified for standard-sized Korean participants.


Subject(s)
Humans , Body Mass Index , Body Size , Cone-Beam Computed Tomography , Korea , Lung Neoplasms , Lung , Mass Screening , Overweight , Pilot Projects , Radiation Dosage , Radiation Exposure , Thinness , Tomography, X-Ray Computed
8.
Korean Journal of Radiology ; : 803-808, 2018.
Article in English | WPRIM | ID: wpr-716328

ABSTRACT

OBJECTIVE: To report the radiological results of a pilot study for the Korean Lung Cancer Screening project conducted to evaluate the feasibility of lung cancer screening using low-dose chest computed tomography (LDCT) in Korea. MATERIALS AND METHODS: The National Cancer Center and three regional cancer centers participated in this study. Asymptomatic current or ex-smokers aged 55–74 years with a smoking history of at least 30 pack-years who had used tobacco within the last 15 years were considered eligible. In total, 256 participants underwent LDCT November 2016 through March 2017. The American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS) was used to categorize the LDCT findings. RESULTS: In total, 57%, 35.5%, 3.9%, and 3.5% participants belonged to Lung-RADS categories 1, 2, 3, and 4, respectively. Accordingly, 7.4% participants exhibited positive findings (category 3 or 4). Lung cancer was diagnosed in one participant (stage IA, small cell lung cancer). Other LDCT findings included pulmonary emphysema (32.8%), coronary artery calcification (30.9%), old pulmonary tuberculosis (11.7%), bronchiectasis (12.9%), interstitial lung disease with a usual interstitial pneumonia pattern (1.2%), and pleural effusion (0.8%). CONCLUSION: Even though the size of our study population was small, the positive rate of 7.4% was like or lower than those in other lung cancer screening studies. Early lung cancer was detected using LDCT screening in one participant. Lung-RADS may be applicable to participants in Korea, where pulmonary tuberculosis is endemic.


Subject(s)
Bronchiectasis , Coronary Vessels , Idiopathic Pulmonary Fibrosis , Information Systems , Korea , Lung Diseases, Interstitial , Lung Neoplasms , Lung , Mass Screening , Pilot Projects , Pleural Effusion , Pulmonary Emphysema , Smoke , Smoking , Thorax , Nicotiana , Tuberculosis, Pulmonary
9.
Cancer Research and Treatment ; : 748-756, 2018.
Article in English | WPRIM | ID: wpr-715830

ABSTRACT

PURPOSE: Because of growing concerns about lung cancer in female never smokers, chest low-dose computed tomography (LDCT) screening is often performed although it has never shown clinical benefits. We examinewhether or not female never smokers really need annual LDCT screening when the initial LDCT showed negative findings. MATERIALS AND METHODS: This retrospective cohort study included 4,365 female never smokers aged 40 to 79 years who performed initial LDCT from Aug 2002 to Dec 2007. Lung cancer diagnosis was identified from the Korea Central Cancer Registry Database registered until December 31, 2013. We calculated the incidence, cumulative probability, and standardized incidence ratio (SIR) of lung cancer by Lung Imaging Reporting and Data System (Lung-RADS) categories showed on initial LDCT. RESULTS: After median follow-up of 9.69 years, 22 (0.5%) had lung cancer. Lung cancer incidence for Lung-RADS category 4 was 1,848.4 (95% confidence interval [CI], 1,132.4 to 3,017.2) per 100,000 person-years and 16.4 (95% CI, 7.4 to 36.4) for categories 1, 2, and 3 combined. The cumulative probability of lung cancer for category 4 was 10.6% at 5 years and 14.8% at 10 years while they were 0.07% and 0.17% when categories 1, 2, and 3 were combined. The SIR for subjects with category 4 was 43.80 (95% CI, 25.03 to 71.14), which was much higher than 0.47 (95% CI, 0.17 to 1.02) for categories 1, 2, and 3 combined. CONCLUSION: Considering the low risk of lung cancer development in female never smokers, it seems unnecessary to repeat annual LDCT screening for at least 5 years or even longer unless the initial LDCT showed Lung-RADS category 4 findings.


Subject(s)
Female , Humans , Cohort Studies , Diagnosis , Follow-Up Studies , Incidence , Information Systems , Korea , Lung Neoplasms , Lung , Mass Screening , Retrospective Studies , Thorax , Tomography, X-Ray Computed
10.
Cancer Research and Treatment ; : 10-19, 2017.
Article in English | WPRIM | ID: wpr-127968

ABSTRACT

PURPOSE: We examined the efficacy of poziotinib, a second-generation epidermal growth factor receptor (EGFR)–tyrosine kinase inhibitor (TKI) in patients with lung adenocarcinoma with activating EGFR mutations, who developed acquired resistance (AR) to EGFR-TKIs. MATERIALS AND METHODS: This single-arm phase II study included EGFR-mutant lung adenocarcinoma with AR to erlotinib or gefitinib based on the Jackman criteria. Patients received poziotinib 16 mg orally once daily in a 28-day cycle. The primary endpoint was progression-free survival (PFS). Prestudy tumor biopsies and blood samples were obtained to determine resistance mechanisms. RESULTS: Thirty-nine patients were treated. Tumor genotyping was determined in 37 patients; 19 EGFR T790M mutations and two PIK3CA mutations were detected in the prestudy tumors, and seven T790M mutations were detected in the plasma assay. Three (8%; 95% confidence interval [CI], 2 to 21) and 17 (44%; 95% CI, 28 to 60) patients had partial response and stable disease, respectively. The median PFS and overall survival were 2.7 months (95% CI, 1.8 to 3.7) and 15.0 months (95% CI, 9.5 to not estimable), respectively. A longer PFS was observed for patients without T790M or PIK3CA mutations in tumor or plasma compared to those with these mutations (5.5 months vs. 1.8 months, p=0.003). The most frequent grade 3 adverse events were rash (59%), mucosal inflammation (26%), and stomatitis (18%). Most patients required one (n=15) or two (n=15) dose reductions. CONCLUSION: Low activity of poziotinib was detected in patients with EGFR-mutant non-small cell lung cancer who developed AR to gefitinib or erlotinib, potentially because of severe-toxicityimposed dose limitation.


Subject(s)
Humans , Adenocarcinoma , Biopsy , Carcinoma, Non-Small-Cell Lung , Disease-Free Survival , Epidermal Growth Factor , Erlotinib Hydrochloride , Exanthema , Inflammation , Lung , Phosphotransferases , Plasma , ErbB Receptors , Stomatitis
11.
Cancer Research and Treatment ; : 465-472, 2016.
Article in English | WPRIM | ID: wpr-210750

ABSTRACT

PURPOSE: Paclitaxel (P) and gemcitabine (G) are clinically synergistic in small cell lung cancer (SCLC). We evaluated the efficacy of PG as a salvage treatment for SCLC patients whose disease progressed after a platinum-containing regimen. MATERIALS AND METHODS: Eligibility included histologically confirmed SCLC, one dimensionally measurable disease, Eastern Cooperative Oncology Group performance status 0-2, and progressive disease after platinum-based chemotherapy. Treatment consisted of P (80 mg/m2) and G (1,000 mg/m2) on days 1 and 8 of each cycle of 21 days until disease progression. RESULTS: Thirty-three patients seen between December 2005 and February 2009 were selected into this study. Thirty patients (91%) had received irinotecan-platinum, and three had received etoposide-platinum. Sixteen patients (49%) had a treatment-free interval of less than 3 months. The overall response rate was 30.3% (29.4% in sensitive relapse and 31.3% in refractory relapse). The median time to progression was 12.0 weeks and median overall survival (OS) 31.0 weeks, with a 1-year OS rate of 30.3%. Toxicities were moderate and manageable with 18.2% grade (G) 4 neutropenia, 24.2% G3 thrombocytopenia, 6.1% G3 sensory neuropathy, and 3% G3 asthenia. One patient developed febrile neutropenia. CONCLUSION: Second-line paclitaxel and gemcitabine were well-tolerated and moderately active in SCLC patients previously treated with platinum-based chemotherapy.


Subject(s)
Humans , Asthenia , Disease Progression , Drug Therapy , Febrile Neutropenia , Neutropenia , Paclitaxel , Recurrence , Small Cell Lung Carcinoma , Thrombocytopenia
12.
Journal of the Korean Medical Association ; : 291-301, 2015.
Article in Korean | WPRIM | ID: wpr-43900

ABSTRACT

Lung cancer is the leading cause of cancer death in many countries, including Korea. The majority of patients are inoperable at the time of diagnosis because symptoms are typically manifested at an advanced stage. A recent large clinical trial demonstrated significant reduction in lung cancer mortality by using low dose computed tomography (LDCT) screening. A Korean multisociety collaborative committee systematically reviewed the evidences regarding the benefits and harms of lung cancer screening, and developed an evidence-based clinical guideline. There is high-level evidence that annual screening with LDCT can reduce lung cancer mortality and all-cause mortality of high-risk individuals. The benefits of LDCT screening are modestly higher than the harms. Annual LDCT screening should be recommended to current smokers and ex-smokers (if less than 15 years have elapsed after smoking cessation) who are aged 55 to 74 years with 30 pack-years or more of smoking-history. LDCT can discover non-calcified lung nodules in 20 to 53% of the screened population, depending on the nodule positivity criteria. Individuals may undergo regular LDCT follow-up or invasive diagnostic procedures that lead to complications. Radiation-associated malignancies associated with repetitive LDCT, as well as overdiagnosis, should be considered the harms of screening. LDCT should be performed in qualified hospitals and interpreted by expert radiologists. Education and actions to stop smoking must be offered to current smokers. Chest radiograph, sputum cytology at regular intervals, and serum tumor markers should not be used as screening methods. These guidelines may be amended based on several large ongoing clinical trial results.


Subject(s)
Humans , Biomarkers, Tumor , Diagnosis , Early Detection of Cancer , Education , Follow-Up Studies , Korea , Lung , Lung Neoplasms , Mass Screening , Mortality , Radiography, Thoracic , Smoke , Smoking , Sputum
13.
Tuberculosis and Respiratory Diseases ; : 318-322, 2012.
Article in English | WPRIM | ID: wpr-114982

ABSTRACT

Sarcoidosis is an inflammatory disease involving multiple-organs with an unknown cause. The new onset of sarcoidosis associated with therapeutic agents has been observed in 3 clinical settings; tumor necrosis factor antagonists in autoimmune rheumatologic diseases, interferon alpha with or without ribavirin in patients with chronic hepatitis C or melanoma, and antineoplastic agent-associated sarcoidosis in patients with hematologic malignancies. Here, we report a female patient who developed sarcoidosis after capecitabine treatment as an adjuvant chemotherapy for sigmoid colon cancer. To our knowledge, this is the first report of a capecitabine-induced sarcoidosis.


Subject(s)
Female , Humans , Chemotherapy, Adjuvant , Deoxycytidine , Fluorouracil , Hematologic Neoplasms , Hepatitis C, Chronic , Interferon-alpha , Melanoma , Ribavirin , Sarcoidosis , Sigmoid Neoplasms , Tumor Necrosis Factor-alpha , Capecitabine
14.
Korean Journal of Medicine ; : 231-236, 2010.
Article in Korean | WPRIM | ID: wpr-41762

ABSTRACT

Lung cancer is the primary cause of cancer mortality in worldwide. However, early lung cancer screening with chest radiography and sputum cytology in 1970s, have failed in reduction of lung cancer mortality, despite the higher proportion of early-stage cancer detection on screening. Therefore, screening for lung cancer has not been recommended. Low dose CT has been recently assessed as a screening tool in observational studies suggesting better impaction than the one obtained with chest radiography. Eight randomized controlled trials are currently under way to evaluate low dose CT as a screening tool for lung cancer. No current data exist to suggest that lung cancer screening with CT will reduce lung cancer mortality.


Subject(s)
Lung , Lung Neoplasms , Mass Screening , Sputum , Thorax
15.
Journal of the Korean Medical Association ; : 1118-1124, 2008.
Article in Korean | WPRIM | ID: wpr-36242

ABSTRACT

Accurate staging of lung cancers is important to determine the treatment options and the prognosis of patients with a lung cancer. TNM system revised in 1997 by American Joint Committee on Cancer and the Union Internationale Contre le Cancer is widely used in staging of the lung cancer. The TNM system is an expression of the anatomic extent of diseases and is based on the assessment of three components; extent of the primary tumor (T), regional lymph node metastasis (N), and distant metastasis (M). Non-invasive staging of lung cancers is based primarily on chest computed tomography (CT), and if available, on positron emission tomography (PET). Chest CT scanning is useful in providing anatomic details, but the accuracy of the chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is poor. PET scanning has a much better sensitivity and specificity than chest CT scanning for mediastinal lymph node staging, and distant metastatic diseases can be detected by PET scanning. With either test, abnormal findings must be confirmed by a tissue biopsy to ensure accurate staging. Invasive techniques for biopsy of mediastinal lymph nodes or pathologic tissue include transbronchial needle aspiration, transesophageal fine needle aspiration, and surgery.


Subject(s)
Humans , Biopsy , Biopsy, Fine-Needle , Dietary Sucrose , Joints , Lung , Lung Neoplasms , Lymph Nodes , Mediastinum , Needles , Neoplasm Metastasis , Neoplasm Staging , Positron-Emission Tomography , Prognosis , Sensitivity and Specificity , Thorax
16.
Korean Journal of Radiology ; : 208-213, 2005.
Article in English | WPRIM | ID: wpr-177522

ABSTRACT

OBJECTIVE: We wanted to describe the findings of simple pulmonary eosinophilia with using 18 fluorodeoxyglucose (FDG) positron emission tomography (PET). MATERIALS AND METHODS: We analysed the findings of 14 patients who underwent thoracic computed tomography (CT) and PET, and then they were subsequently proven to have simple pulmonary eosinophilia. PET studies were performed in four patients with malignancy to evaluate for cancer metastasis, and PET scans were also done in 10 healthy subjects who underwent volunteer cancer screening. The PET scans were evaluated by using the maximum standardized uptake values (SUVs). The subjects' CT findings also were reviewed and correlated with the PET findings. RESULTS: A total of 42 nodules were detected on the CT scans. There were single nodules in three patients and multiple nodules in 11 patients (mean number of nodules: 3, range: 1-10, mean diameter: 9.5 mm+/-4.7). Twelve of 42 (28.6%) nodules showed FDG uptake and their mean maximum SUV was 2.5+/-1.6 (range: 0.6-5.3). Five of six solid nodules showed FDG uptake (2.2+/-1.1, range: 0.9-3.6), six of 11 semisolid nodules showed FDG uptake (3.1+/-1.8, range: 0.6-5.3) and one of 25 pure ground-glass opacity nodule showed a maximum SUV of 0.8. The maximum SUVs of seven nodules in five patients were greater than 2.5. The maximum SUVs were significantly different according to the nodule types (p < 0.001). CONCLUSION: Simple pulmonary eosinophilia commonly causes an increase in FDG uptake. Therefore, correlation of the PET findings with the CT findings or the peripheral eosinophil counts can help physicians arrive at the correct diagnosis of simple pulmonary eosinophilia.


Subject(s)
Middle Aged , Male , Humans , Female , Aged , Adult , Tomography, X-Ray Computed , Radiopharmaceuticals , Pulmonary Eosinophilia/diagnostic imaging , Positron-Emission Tomography , Lung Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18
17.
Journal of the Korean Radiological Society ; : 191-196, 2002.
Article in Korean | WPRIM | ID: wpr-162618

ABSTRACT

PURPOSE: To determine the specific high-resolution CT features of sarcoidosis in which the observed pattern is predominantly pseudoalveolar. MATERIALS AND METHODS: We retrospectively reviewed the HRCT findings in 15 cases in which chest radiography demonstrated pseudoalveolar consolidation. In all 15, sarcoidosis was pathologically proven. The distribution and characterization of the following CT features was meticulously scrutinized: distribution and characterization of pseudoalveolar lesions, air-bronchograms, micronodules, thickening of bronchovascular bundles and interlobular septa, lung distortion, ground-glass opacities and combined hilar and mediastinal lymphadenopathy. Follow-up CT scans were available in three cases after corticosteroid administration. RESULTS: Between one and 12 (mean, 5.6) pseudoalveolar lesions appeared as dense homogeneous or inhomogeneous opacities 1-4.5 cm in diameter and with an irregular margin located either at the lung periphery adjacent to the pleural surface or along the bronchovascular bundles, with mainly bilateral distribution (n=14, 93%). An air-bronchogram was observed in ten cases. Micronodules were observed at the periphery of the lesion or surrounding lung, which along with a thickened bronchovascular bundle was a consistent feature in all cases. Additional CT features included hilar and mediastinal lymphadenopathy (n=14, 93%), thickened interlobular septa (n=12, 80%), and ground-glass opacity (n=10, 67%). Lung distortion was noted in only one case (7%). After steroid administration pseudoalveolar lesions decreased in number and size in all three cases in which follow-up CT was available. CONCLUSION: The consistent HRCT features of pseudoalveolar sarcoidosis are bilateral multifocal dense homogenous or inhomogenous opacity and an irregular margin located either at the lung periphery adjacent to the pleural surface or along the bronchovascular bundles. Micronodules are present at the periphery of the lesion or surrounding lung. The features are reversible at steroid administration.


Subject(s)
Follow-Up Studies , Lung , Lymphatic Diseases , Radiography , Retrospective Studies , Sarcoidosis , Thorax , Tomography, X-Ray Computed
18.
Korean Journal of Radiology ; : 138-144, 2001.
Article in English | WPRIM | ID: wpr-100805

ABSTRACT

OBJECTIVE: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. MATERIALS AND METHODS: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. RESULTS: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). CONCLUSION: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.


Subject(s)
Aged , Female , Humans , Male , Carcinoma, Bronchogenic/complications , Lung Neoplasms/complications , Middle Aged , Tomography, X-Ray Computed , Tuberculosis, Pulmonary/complications
19.
20.
Journal of the Korean Radiological Society ; : 765-770, 2000.
Article in Korean | WPRIM | ID: wpr-202523

ABSTRACT

PURPOSE: To compare the accuracy of thick-and thin-section spiral CT and to determine whether, in diagnosing mediastinal lymph node metastasis from non-small cell lung cancer, the latter is superior to the former. MATERIALS AND METHODS: Between March 1997 and March 1998, 51 patients with pathologically proven non-s-mall cell lung cancer underwent thoracotomy with full nodal dissection. Thick- and thin-section spiral CT were performed in all patients, with a mean interval of 14 days. The former was performed with 10 mm thick-ness and 10 mm interval, and the latter with 3 mm thickness and 3 mm interval. Mediastinal lymph nodes were localized according to the lymph node mapping scheme of the American Thoracic Society and were considered positive for metastasis if they exceeded 10 mm in short-axis diameter. RESULTS: A total of 227 mediastinal nodal stations in 51 patients were obtained. Of these, 188 stations included in thin-section spiral CT were analyzed and the prevalence of ediastinal nodal metastasis was found to be 10%. On a station-by-station basis, and for thick-and thin-section spiral CT, respectively, the overall sensitivi-ties of mediastinal lymph node metastasis were 32% and 53% (p .05). Although there were no statistically significant differences in sensitivity and specificity according to nodal station, thin-section spiral CT tended to be superior to the thick-section type for stations 7 and 10R in terms of sensitivity, and for stations 4L and 5 in terms of specificity. CONCLUSION: Thin-section spiral CT was more sensitive than thick-section spiral CT is the evaluation of medi-astinal lymph node metastasis from non-small cell lung cancer. This may be due to the higher resolution of the former and its ability to discriminate between lymph node and vessel.


Subject(s)
Humans , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Lymph Nodes , Neoplasm Metastasis , Prevalence , Sensitivity and Specificity , Thoracotomy , Tomography, Spiral Computed
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