Comparison of 16S Ribosomal RNA Targeted Sequencing and Culture for Bacterial Identification in Normally Sterile Body Fluid Samples: Report of a 10-Year Clinical Laboratory Review

As 16S ribosomal RNA (rRNA)-targeted sequencing can detect DNA from non-viable bacteria, it can be used to identify pathogens from clinical samples even in patients pretreated with antibiotics. We compared the results of 16S rRNA-targeted sequencing and culture for identifying bacterial species in normally sterile body fluid (NSBF): cerebrospinal, pericardial, peritoneal and pleural fluids. Over a 10-year period, a total of 312 NSBF samples were evaluated simultaneously using 16S rRNA-targeted sequencing and culture. Results were concordant in 287/312 (92.0%) samples, including 277 (88.8%) negative and 10 (3.2%) positive samples. Of the 16 sequencing-positive, culture-negative samples, eight showed clinically relevant isolates that included Fusobacterium nucleatum subsp. nucleatum, Streptococcus pneumoniae, and Staphylococcus spp. All these samples were obtained from the patients pretreated with antibiotics. The diagnostic yield of 16S rRNA-targeted sequencing combined with culture was 11.2%, while that of culture alone was 6.1%. 16S rRNA-targeted sequencing in conjunction with culture could be useful for identifying bacteria in NSBF samples, especially when patients have been pretreated with antibiotics and when anaerobic infection is suspected.

Role of Rigid Thoracoscopy in Undiagnosed Pleural Effusion: A Prospective Study

Background: Medical thoracoscopy is a minimally invasive, safe, and cost-effective procedure that allows complete visualizationof pleural space, enabling diagnostic and therapeutic procedures such as pleural biopsy and talc insufflations. Conservativeestimates suggest that 25% of patients seen in general pulmonologist’s practice involve pleura, of these 25% are unable to beattributed to a specific diagnosis, even after thoracentesis and closed pleural biopsy.Aim: The aim of this study was to evaluate the diagnostic yield of rigid thoracoscopy in undiagnosed pleural effusion.Methods: This prospective observational descriptive study was conducted in Thanjavur Medical College Hospital, Tamil Nadu,in the Department of Thoracic Medicine between July 2017 and December 2018. Rigid thoracoscopy equipment was used forinvestigation. 12 undiagnosed pleural effusion patients after thoracentesis who fulfilled inclusion and exclusion criteria wereincluded in the study.Results: Of the 12 patients, six were male and six were female; seven had right-sided pleural effusion and five had left sidedpleural effusion. Investigation reports were inconclusive except for suggesting an exudative effusion. Cytological examinationsof pleural fluid were inconclusive in all the patients. After thoracoscopy, tuberculosis was diagnosed in five cases, metastasesin three cases, mesothelioma in two cases, and inflammatory pathology in two cases.Conclusion: Thoracoscopy is a safe procedure with high diagnostic yield in undiagnosed exudative pleural effusion (EPE).Asimple, minimally invasive low-cost investigation reduces the need for more invasive and much more expensive thoracotomy.Our study proved that rigid thoracoscopy remains the investigation of choice in all undiagnosed EPE for accurate diagnosisand management.

Comparison of the Diagnostic Yield of the Standard 22-Gauge Needle and the New 20-Gauge Forward-Bevel Core Biopsy Needle for Endoscopic Ultrasound-Guided Tissue Acquisition from Pancreatic Lesions

BACKGROUND/AIMS: To compare the diagnostic yield of 20-gauge forward-bevel core biopsy needle (CBN) and 22-gauge needle for endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) of solid pancreatic masses. METHODS: The use of 20-gauge CBN was prospectively evaluated for 50 patients who underwent EUS-FNA from June 2016 to December 2016. Data were compared with those obtained by a retrospective study of 50 consecutive patients who underwent EUS-FNA using standard 22-gauge needles between December 2016 and April 2017. At least two punctures were performed for each patient; the sample from the first pass was used for cytology with or without histology and that from the second pass was used for histology. Sample quantity was evaluated using the sample obtained from the second pass. RESULTS: There was no significant difference in the diagnostic accuracy rate between the first and second passes (20-gauge CBN: 96% [48/50]; standard 22-gauge needle: 88% [44/50]). Samples >10× power fields in length were obtained from 90% (43/48) and 60% (30/50) of patients using the 20-gauge CBN and standard 22-gauge needle, respectively (p=0.01). Technical failure occurred for two patients with the 20-gauge CBN. CONCLUSIONS: Diagnostic accuracy of the 20-gauge CBN was comparable to that of the 22-gauge needle. However, two passes with the 20-gauge CBN yielded a correct diagnosis for 100% of patients when technically feasible. Moreover, the 20-gauge CBN yielded core tissue for 90% patients, which was a performance superior to that of the 22-gauge needle.

Role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions: A hospital based cross sectional study

Background: To obtain the good amount of specimen by biopsy for proper diagnosis, thoracoscopy is a very good tool. Using thoracoscopy the diagnostic accuracy can reach 100% whereas the diagnostic accuracy of the closed pleural biopsy is around 51-79%. Aim: To study role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions. Material and Methods: A hospital based cross sectional study was carried out among 50 study subjects aged > 45 years. All were cases of pleural effusion. Thoracoscopic pleural biopsy was performed in all cases. The samples were sent for histopathology after biopsy. Results: Majority of the study subjects were found to be in the age group of 45-55 years i.e. 60%. Males outnumbered females as the pleural effusion may be more common in males above the age of 45 years than among the females. Tuberculosis was more in females (60%) than males (40%). But malignancy – adenocarcinoma spreading to pleura was more common in males (90.5%) than females (9.5%). Only one female was found to have Meigs syndrom (ovarian tumor with secondaries pleura). Mesothelioma was seen in three cases and all of them were males. Normal histopathology finding was seen in five cases and all of them were males. It has been documented that pleural effusion due to tuberculosis was more common in females in the present study. Kiran Grandhi, Jayasri Helen Gali, Kokiwar PR. Role of thoracoscopic pleural biopsy in low Adenosin DeAminase pleural effusions: A hospital based cross sectional study. IAIM, 2019; 6(1): 83-88. Page 84 Conclusion: Thoracoscopic pleural biopsy diagnostic yield is high. Low ADA level in pleural fluid does not rule out kochs, incidence more in females.

Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding

OBJECTIVE: To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding. MATERIALS AND METHODS: A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis. RESULTS: The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09–9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21–6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-α therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07–0.95; p = 0.041). CONCLUSION: The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.

Effectiveness of Capsule Endoscopy Compared with Other Diagnostic Modalities in Patients with Small Bowel Crohn’s Disease: A Meta-Analysis

BACKGROUND/AIMS: As a result of the rapid development of medical diagnostic tools, physicians require concrete evidence to evaluate the effectiveness of the tools. We aimed to investigate the effectiveness and additional diagnostic benefits of capsule endoscopy (CE) in patients with small bowel Crohn’s disease (CD). METHODS: We performed a systematic search of databases, including MEDLINE, EMBASE, and the Cochrane Library, as well as eight domestic databases. Two reviewers independently screened all references. Diagnostic data from the studies were collected, and a meta-analysis was performed. RESULTS: Twenty-four studies were included. In cases of suspected CD, CE demonstrated a superior diagnostic yield compared with small bowel follow-through (SBFT) and enteroclysis (EC); however, there was no difference compared with computed tomography enterography or magnetic resonance enterography. In cases with established CD, CE demonstrated a higher diagnostic yield only compared with EC. In the detection of terminal ileum lesions, CE exhibited a significantly increased detection rate compared with ileoscopy. CONCLUSIONS: The findings of our meta-analysis indicate that CE is superior to SBFT and EC in the evaluation of suspected CD cases. CE is also a more effective diagnostic modality in patients with established CD compared with EC.

Appropriateness of Indication and Diagnostic Yield of Colonoscopy in a Southern Nigerian Tertiary Hospital.

Background and Objectives: For optimum use of resources in an open access system, official guidelines for the appropriate use of colonoscopy have been proposed by the American Society for Gastrointestinal Endoscopy (ASGE). The objectives of this study were to determine the appropriateness of referrals and to assess the diagnostic yield of colonoscopy based on the 2000 ASGE guidelines. Methods: This was a retrospective study of patients that had colonoscopy in the University of Benin Teaching Hospital from January 2010 to December 2014. The biodata, indications for the procedure, and findings at colonoscopy were retrieved from the colonoscopy register of the endoscopy unit. The year 2000 ASGE guidelines were used to determine the appropriateness of indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for the indication. Results: Of the 283 patients (158 males; 125 females; mean age 55.2±15.0 years) studied, 66% had colonoscopy for an indication that was considered ‘generally indicated’. It was ‘generally not indicated’ for 2.5%, while 31.4% underwent colonoscopy for reasons ‘not listed’ in the guidelines. The diagnostic yield of the procedure was significantly higher in the ‘generally indicated’ group (41.7%) than in the ‘not listed’ (29.2%) and the generally not indicated (0%) groups. In the multivariate analysis, diagnostic yield was associated with appropriateness of indications that was’ generally indicated’ (odds ratio=1.263, confidence interval=1.072-1.488). Conclusion: About one third of patients had colonoscopy performed for reasons considered inappropriate by the ASGE 2000 guidelines. The diagnostic yield of colonoscopy is predicted by the appropriateness of the indication. Positive diagnostic yield also occurs in the unlisted category. Further studies are required to evaluate the indications for colonoscopy and the possibility of adding some of the unlisted indications to the ASGE guidelines in future revisions. There is need to develop a local guideline well adapted to our environment.

Comparison between CT Colonography and Double-Contrast Barium Enema for Colonic Evaluation in Patients with Renal Insufficiency

OBJECTIVE: To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. MATERIALS AND METHODS: Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean +/- SD in age, 51 +/- 6.4 years) and CTC (n = 176; 50 +/- 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of > or = 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups. RESULTS: Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups. CONCLUSION: In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.

Diagnostic Yield of Pediatric Colonoscopies Based on Presenting Symptoms in a Secondary Hospital / 대한소아소화기영양학회지

PURPOSE: We performed this study retrospectively to review the diagnostic yield of colonoscopies in children and adolescents with various gastrointestinal symptoms and to investigate the relationship between presenting symptoms and the colonoscopic findings in a secondary hospital. METHODS: We reviewed the medical records of patients under the age of 19-years who underwent ileocolonoscopy between January 2001 and December 2010. The total number of patients (n=238) were divided into three age groups and six symptom groups. We analyzed clinical characteristics and the colonoscopic findings, and compared the colonoscopic yield between each groups. RESULTS: The median age of the patients was 16.1 (3.1~18.9) years. The most common presenting symptoms were lower gastrointestinal (GI) bleeding (48.1%) in the or =16 years group (n=126). Positive colonoscopic findings were found in 21.4% of the bowel habit change group (n=28), 51.9% of the low GI bleeding group (n=54), 37.7% of the chronic diarrhea group (n=69), and 94.4% of the group with suspected inflammatory bowel disease (IBD) (n=18), 38.9% of the chronic abdominal pain group (n=54) and 13.3% of the anemia group (n=15). The diagnostic yield of the total examination was 42.0%. The suspected IBD group had a higher yield than the presenting symptom groups (p<0.001). CONCLUSION: Colonoscopy is a safe and useful investigation in children and adolescents with suspected colonic disease. The diagnostic yield of colonoscopy is higher in patients presenting with suspected IBD. Pediatricians practicing in primary or secondary care settings should recommend colonoscopy for patients with suspected IBD.

Factors Affecting Complete Small Bowel Study and Diagnostic Yield in MiroCam(R) Capsule Endoscopy

BACKGROUND/AIMS: Mirocam(R) capsule endoscopy has been widely used in Korea; however, data with respect to Mirocam(R) capsule endoscopy is lacking. We have assessed the factors affecting complete small bowel studies and diagnostic yield in Mirocam(R) capsule endoscopic studies. METHODS: We retrospectively analyzed 103 cases that were assessed with Mirocam(R) capsule endoscopy between June 2007 and February 2010 at Guro Korea University Hospital. RESULTS: The mean age of the 103 cases was 55.47 years (range, 16-99 years) and 67 cases (65%) were male. The indications for capsule endoscopy were hematochezia/melena (77 cases, 74.8%), anemia (8 cases, 7.8%), abdominal pain (12 cases, 11.7%), and miscellaneous (weight loss and chronic diarrhea; 6 cases, 5.8%). The mean stomach transit time was 59.9+/-88.3 minutes (range, 1-630 minutes) and the mean small bowel transit time was 396.0+/-131.7 minutes (range, 117-708 minutes). The rate of successfully performing a complete small bowel study was 82.5% (85 cases), and the stomach transit time was a significant factor for a complete small bowel study (OR=0.991, 95% CI=0.984-0.998, P=0.012). The diagnostic yield was 51.5% (53 cases); visual quality was a significant factor in determining the diagnostic yield (OR=6.776, 95% CI=1.32-34.70, P=0.022). CONCLUSIONS: In a Mirocam(R) capsule endoscopic study, short stomach transit time was a significant factor affecting completion of the small bowel study. Achieving excellent visual quality by good bowel preparation was a significant factor for improving the diagnostic yield.

Does Back-To-Back Capsule Endoscopy Increase the Diagnostic Yield over a Single Examination in Patients with Obscure Gastrointestinal Bleeding?

BACKGROUND/AIMS: Video capsule endoscopy (CE) can provide a negative result despite the presence of clinically significant small-bowel lesions. We therefore performed a prospective study to elucidate whether repeated back-to-back CE increases the diagnostic yield over a single CE in patients with obscure gastrointestinal bleeding (OGIB). METHODS: Sixteen patients with OGIB were prospectively enrolled and underwent back-to-back CE investigation with a 24-hour interval. All CE videos were interpreted by two experienced readers at a maximum 15 frames/second in a random order. RESULTS: The diagnostic yield of the single CE was 37.5% for the first CE, 43.8% for the second CE, and 62.5% for the back-to-back CE. The overall mean lesion-detection rates of the first and second CEs were 42.2% and 64.6%, respectively. The bowel preparation status of the second CE was improved in 37.5% and unchanged in 62.5% of cases as compared with that of the first CE. CONCLUSIONS: These results indicate that back-to-back CE may increase the diagnostic yield and lesion-detection rate over a single CE in patients with OGIB. Therefore, if the first CE is not diagnostic in a patient with OGIB, repeat back-to-back CE may be considered as a candidate for further workup.

The Appropriateness of Colonoscopy Indication and the Diagnostic Yield of Colonoscopy / 대한소화기내시경학회지

BACKGROUND/AIMS: We wanted to evaluate if the guidelines for appropriately performing colonoscopy by the American Society for Gastrointestinal Endoscopy (ASGE) yield good diagnostic efficacy, and we wanted to assess the appropriateness of referrals. METHODS: A total of 2,412 consecutive patients (1,605 men and 807 women) who were undergoing colonoscopy from September 2006 to February 2007 were prospectively enrolled in the study. The diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of performed colonoscopies. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. RESULTS: The large majority (64.2%) of patients had colonoscopy for an indication that was considered 'generally indicated', while the procedure was considered 'generally not indicated' for 22.4% of the patients. The diagnostic yield of colonoscopy was significantly higher for the appropriate colonoscopies (59.1%) than for the inappropriate colonoscopies (23.2%). On the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of the indication that was "generally indicated" (odds ratio=9.5) and with the referrals by a gastroenterologist (odds ratio=1.7). CONCLUSIONS: The ASGE guidelines have shown a good diagnostic yield. Further steps are required to update and standardize the guidelines to increase the diagnostic yield.

Analysis of the Factors that Affect the Diagnostic Yield of Capsule Endoscopy in Patients with Obscure Gastrointestinal Bleeding / 대한소화기학회지

BACKGROUND/AIMS: Capsule endoscopy (CE) has become a valuable modality for the detection of small bowel lesions. The usefulness of CE for obscure gastrointestinal (GI) bleeding has been established with an overall diagnostic yield of 60%. It is unknown whether CE is of equal value in all the patients or of greater benefit in selected groups in Korea. We evaluated the factors that affect the diagnostic yields of CE in patients with obscure GI bleeding. METHODS: CE was performed in 126 consecutive patients [74 men and 52 women mean age : 52.5 years (25-75 yrs), 23 with active bleeding] with obscure GI bleeding between September 2002 and July 2004. Patients were divided into two groups: those with documented bleeding lesions and those with non specific CE findings. We analyzed the clinical characteristics and other parameters that influenced the diagnostic yields of CE. RESULTS: A definite or probable cause for obscure GI bleeding was found in 69% (80/116) of the patients. NSAID induced ulcer (16.4%) and angiodysplasia (12.1%) were the most common diagnoses. In patients with active bleeding, the diagnostic yield was significantly greater than that of the patients with occult bleeding (80% vs. 68.3%, p<0.05). However, there was no significant difference in parameters between patients with abnormal CE and those with normal CE in respect to gender, age, previous bleeding history, need for transfusion, cecum imaging, and bowel preparation. CONCLUSIONS: The diagnostic yield of CE in patients with obscure GI bleeding is 69%. It is significantly higher in patients with active bleeding.

Diagnostic Yield of Emergency Brain Magnetic Resonance Imaging in the Evaluation of Patients with Acute Dizziness in a University Hospital

BACKGROUND: Dizziness is one of the most common neurological symptoms for visiting the emergency department. Acute vertigo and severe imbalance may be the only presenting features of cerebellar stroke that could masquerade as a peripheral vestibular lesion. Magnetic resonance images (MRI) proved to be very sensitive in detecting acute stroke involving brainstem or cerebellum. In this retrospective study, we investigated the diagnostic yield of emergency brain MRI among the patients who visited emergency department with acute dizziness. METHODS: We reviewed the medical records of consecutive patients with acute dizziness who were seen in emergency department of Cheju National University Hospital between May 2005 and Oct 2006. We collected following the information from medical records. (1) Age, sex, and blood pressure at emergency department (2) Type, duration, accompanying symptoms of dizziness and positive finding from neurological and neuro-otological examination (3) Vascular risk factors (4) Results of MRIs. RESULTS: During the study period, 360 patients visited emergency department due to isolated acute dizziness. Emergent MRIs were performed in 84 (23.3%) patients. Although about 90% of them were older than 50 years and 60% of them had at least one or more vascular risk factors, central causes of dizziness were found in only five patients including four acute cerebellar infarctions and a cerebellar hemorrhage. Diagnostic yield of emergent MRI was only 6%. CONCLUSIONS: In this study, emergency brain MRIs showed limited diagnostic yield among patients who visited emergency department with acute isolated dizziness.

The Clinical Usefulness of Transbronchial Lung Biopsy in Critically Ill Patients with Pulmonary Infiltrates of Uncertain Etiology / 결핵

BACKGROUND: Transbronchial lung biopsy (TBLB) has known to yield useful information for pulmonary infiltrates of uncertain etiology. However, the its safety and usefulness of TBLB has have not been conclusive in the critically ill patients with respiratory failure. Moreover, TBLB has not been recommended for patients with mechanical ventilation. This study was done conducted to investigate the diagnostic values and risks of TBLB performed on critically ill patients at bedside to obtain information on the pulmonary infiltrate of unknown etiology. METHODS: Twenty patients (21 admissions with 23 cases) with diffuse pulmonary infiltrates who were treated in a medical intensive care unit of a tertiary referral hospital from January 1994 to May 1998, were enrolled for this study. Their medical records were retrospectively reviewed. TBLB was opted when a noninvasive diagnostic work-up failed to reveal the cause for the pulmonary infiltrate. The procedure was performed at patients' bedside without assistance of fluoroscopy. Bronchial washing or bronchoalveolar lavage was performed on the same pulmonary segment before performing TBLB. RESULTS: Adequate specimens were obtained in 18 cases (78%). TBLB provided specific diagnosis in two cases. The results of TBLB suggested the underlying etiology in 9 cases; bacterial pneumonitis (4), hypersensitivity pneumonitis (1), polymyositis (1), radiation fibrosis (1), idiopathic pulmonary fibrosis (1), and BOOP (1). Therapeutic decisions were altered in 11 cases (47.8 %) based on the TBLB results. Pneumocystis carinii was found in the BAL fluid of another case. Ten patients with a therapeutic change and ten patients without a management change had mortality rates of 40% and 80%, respectively. The APACHE III scores were significantly higher in patients with complications (72.8+/-21.8) compared with those without complications (48.3+/-18.9) (p< 0.05). The complication rates were higher in those with mechanical ventilation (50 %) than in those without mechanical ventilation (33 %)(,) but the difference was not statistically significant (p= 0.3). Conclusions: TBLB may be a useful diagnostic option for critically ill patients with unknown cause of pulmonary infiltrates. However, it should be be used with care for patients with mechanical ventilation or for severely ill patients.

Stereotactic Biopsy in Brain Lesions

The authors present a retrospective analysis of 100 consecutive patients who between February 1993 and June 1996 underwent computed tomography(CT)-guided stereotactic biopsy using the Riechert-Mundinger system. The patients were aged between ten and 70(mean 41) years and the male-to-female ratio was 58 : 42. All were suffering from intracranial lesion(s) which had not been correctly diagnosed by CT and/or magnetic resonance(MR) imaging. Among these 100 patients, 102 stereotactic biopsy procedures were carried out ; in two cases, the procedure was repeated, due to initial failure. Diagnostic yield was 92%(94 procedures) and the accuracy by image was 100%. After biopsy, eleven glioma cases underwent craniotomy ; in ten of these(92%), the diagnosis was the same on craniotomy and on biopsy. The exception had on biopsy been diagnosed as anaplastic astrocytoma, but on craniotomy was diagnosed as anaplastic oligoastrocytoma. The treatment plan for 27 of 85 patients(31%) was changed after biopsy. The mortality rate was 1%(one case) ; after biopsy, a patient with brain abscess and impending herniation died due to progressive brain edema. The morbidity rate was 7%(seven cases) ; one patient showed transient symptoms of increased intracranial pressure, five showed transient weakness, and one, transient speech disturbance. In conclusion, our system for CT-guided stereotactic biopsy is highly diagnostic, accurate, effective for treatment planning, and in diagnosing brain lesions, does not damage tissue. The possible causes and the solutions for non-specific diagnoses are also discussed.

The Diagnostic Yield and Complications ofPercutaneous Needle Aspiration Biopsy for the Intrathoracic Lesions / 결핵

Bacground: Percutaneous needle aspiration biopsy (PCNA) is one of the most frequently used diagnostic methods for intrathoracic lesions. Previous studies have reported wide range of diagnostic yield from 28 to 98%. However, diagnostic yield has been increased by accumulation of experience, improvement of needle and the image guiding systems. We analysed the results of PCNA performed for one year to evaluate the diagnostic yield, the rate and severity of complications and factors affecting the diagnostic yield. Method: 287 PCNAs undergone in 236 patients from January, 1994 to December, 1994 were analysed retrospectively. The intrathoracic lesions was targeted and aspirated with 21-23 G Chiba needle under fluoroscopic guiding system. Occasionally, 19-20 G Biopsy gun was used for core tissue specimen. The specimen was requested for microbiologic, cytologic and histopathologic examination in the case of obtained core tissue. Diagnostic yields and complication rate of benign and malignant lesions were calculated based on patients' charts. The comparison for the diagnostic yields according to size and shape of the lesions was analysed with chi square test (p<0.05). Results: There are 19.9% of consolidative lesion and 80.1% of nodular or mass lesion, and the lesion is located at the right upper lobe in 26.3% of cases, the right middle lobe in 6.4%, the right lower lobe 21.2%, the left upper lobe in 16.8%, the left lower lobe in 10.6%, and mediastinum in 1.3%. The lesion distributed over 2 lobes is as many as 17.4% of cases. There are 74 patients with benign lesions, 142 patients with malignant lesions in final diagnosis and confirmative diagnosis was not made in 22 patients despite of all available diagnostic methods. 2 patients have lung cancer and pulmonary tuberculosis concomittantly. Experience with 236 patients showed that PCNA can diagnose benign lesions in 62.2% (42 patients) of patients with such lesions and malignant lesions in 82.4% (117 patients) of patients. For the patients in whom the first PCNA failed to make diagnosis, the procedure was repeated and the cumulative diagnostic yield was increased as 44.6%, 60.8%, 62.2% in benign lesions and as 73.4%, 81.7%, 82.4% in malignant lesions through serial PCNA. Thoracotomy was performed in 9 patients with benign lesions and in 43 patients with malignant lesions. PCNA and thoracotomy showed the same pathologic result in 44.4% (4 patients) of benign lesions and 58.1% (25 patients) of malignant lesions. Thoracotomy confirmed 4 patients with malignat lesions against benign result of PCNA and 2 patients with benign lesions against malignant result of PCNA. There are 1.0% (3 cases) of hemoptysis, 19.2% (55 cases) of blood tinged sputum, 12.5% (36 cases) of pneumothorax and 1.0% (3 cases) of fever through 287 times of PCNA. Hemoptysis and blood tinged sputum didn't need therapy. 8 cases of pneumothorax needed insertion of classical chest tube or pig-tail catheter. Fever subsided within 48 hours in all cases. There was no difference between size and shape of lesion with diagnostic yield. Conclusion: PCNA shows relatively high diagnostic yield and mild degree complications but the accuracy of histologic diagnosis has to be improved.