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.

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.

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.

Differences of Diagnostic Rate According to Technique of Bronchial Brush in the Diagnosis of Lung Cancer / 대한암학회지

PURPOSE: Brush cytology is one of useful methods for establishing a diagnosis of lung cancer. There are two methods of retrieving the specimen of brush cytology. One is to withdraw the brush through the working channel of the bronchoscope (withdrawn brush) and the other is to withdraw the brush and bronchoscope as a unit, with brush remaining protruded through the distal tip of the bronchoscope (nonwithdrawn brush). We tried to compare two methods in the cellularity of the specimen and the diagnosis of lung cancer. MATERIALS AND METHODS: Thirty-one patients with suspected lung cancer were studied prospectively. The sequence of sampling (withdrawn or nonwithdrawn brush) was assigned randomly. The specimens were interpreted by two cytopathologists about cellularity (1-4) and presence of recognizable malignant cells. RESULTS: Cellularity was significantly greater for nonwithdrawn brush (p<0.05). There was no significant difference of diagnostic rate between both methods in the diagnosis of lung cancer. CONCLUSION: Withdrawing the brush through the bronchoscope decreases the cellularity, but it does not affect the diagnostic rate for lung cancer.

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.

Is Premedication necessary for Outpatient Fiberoptic Bronchoscopy / 결핵

No abstract available.