Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Utility of Scalene Lymph Node Biopsy in the Diagnosis of Sarcoidosis

유육종증 진단에서의 사각근 림프절 생검의 유용성

  • Chung, Won-Sang (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Kim, Young-Hak (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Song, Young-Joo (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Kim, Ji-Hoon (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University) ;
  • Kim, Hyuck (Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital, College of Medicine, Hanyang University)
  • 정원상 (한양대학교 의과대학 서울병원 흉부외과학교실) ;
  • 김영학 (한양대학교 의과대학 서울병원 흉부외과학교실) ;
  • 송영주 (한양대학교 의과대학 서울병원 흉부외과학교실) ;
  • 김지훈 (한양대학교 의과대학 서울병원 흉부외과학교실) ;
  • 김혁 (한양대학교 의과대학 서울병원 흉부외과학교실)
  • Received : 2010.06.25
  • Accepted : 2010.08.17
  • Published : 2010.12.05
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Abstract

Background: In addition to clinical and radiographic findings, a histopathologic examination is important in the diagnosis of sarcoidosis. This study evaluated the diagnostic usefulness of a scalene node biopsy in patients with suspected sarcoidosis. Material and Method: We studied 35 patients who underwent scalene node biopsy because of suspicion of sarcoidosis on a chest x-ray and a computerized tomogram between 2001 and 2009, regardless of symptoms. Result We studied 15 men and 20 women whose mean age was $41.51{\pm}11.21$ years (25~64). Three among the 35 were diagnosed with tuberculosis and 27 with sarcoidosis, resulting in a diagnostic yield of 84.4%. The mean lymph node diameter size was 1.3 (${\pm}0.12$) (0.3~3.6 cm) cm. We divided the group of participants according to stage - whether on chest x-ray the lung was affected or not (stage 0, 1 and stage 2, 3). We divided lymph node sizes as well - whether they were larger than 1 cm or smaller than 1 cm. For these subgroups, there were no significant differences in diagnostic yield (p=0.604) (p=0.084). There were no complications or mortality. Conclusion: Scalene node biopsies are simply done under local anesthesia, without major complications. They have a high diagnostic yield regardless of the stages of the disease and lymph node size. We conclude that scalene node biopsy is a good alternative to other biopsy methods in sarcoidosis.

배경: 유육종증의 진단에는 임상적, 방사선학적 소견과 함께 조직검사가 중요하다. 이 연구는 유육종증이 의심되는 환자에서 사각근 림프절 생검이 가지는 진단적 유용성을 평가하고자 한다. 대상 및 방법: 2001년부터 2009년까지 본원에서 증상 유무와 상관없이 시행한 단순흉부촬영과, 흉부컴퓨터단층촬영상 유육종증이 의심되는 환자 중 사각근 림프절 생검을 시행한 35명을 대상으로 하였다. 결과: 남자는 15명 여자는 20명이었으며 평균 나이는 $41.51{\pm}11.21$세 (25~64)였다. 35명 중 3명이 결핵을 진단 받았고 32명 중 27명이 유육종증을 진단 받아 84.4%의 진단율을 얻었다. 사각근 림프절 크기의 평균은 1.26 (${\pm}0.11$) (0.3~3.6 cm) 였다. 단순흉부촬영 상 폐침윤 여부에 따라 두 군으로 나누었을 때 (0기와 1기, 2기와 3기), 그리고 림프절의 크기가 1 cm 이상인 군과 1 cm 미만인 군으로 나누었을 때 각각의 경우 두 군의 양성 판정율에 유의한 차이는 없었다(p=0.604) (p=0.085). 수술 합병증 및 사망률은 없었다. 결론: 사각근 림프절 생검은 국소마취 하에 간단하게 큰 합병증 없이 시행될 수 있으며 질환의 병기나 림프절의 크기에 관계 없이 높은 진단율을 나타내었다. 사각근 림프절 생검은 유육종증의 진단에 있어서 다른 조직검사 방법들을 대신하여 시행할 수 있는 좋은 방법이다.

Keywords

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