• 대한기관식도과학회지
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• 제17권1호
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• pp.9-13
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• 2011

Endobronchial ultrasound (EBUS), which enables visualization of lesions beyond the bronchus, broadens the fields of bronchoscopy. Two types of ultrasound, radial and linear, are used for bronchoscopy. Radial EBUS is performed by inserting an ultrasound mini-probe through the working channel of a flexible bronchoscope. Evaluation of the depth of invasion of early endobronchial lung cancers using radial EBUS is useful in deciding endobronchial treatment. A central tumor limited to within the cartilaginous layer is a good indication for endobronchial photodynamic therapy. EBUS-guide sheath (GS) technique is a sampling method assisted by localization of peripheral lesions using EBUS. The diagnostic yield of EBUS-GS method is higher than that of conventional transbronchial biopsy. High diagnostic values of EBSU-GS method are reported even in small (${\leq}2cm$) peripheral tumors. Linear EBUS is used for endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA). EBUS-TBNA has high diagnostic yields in mediastinal staging of lung cancer even in patients having radiologically early stage lung cancers with normal CT or PET findings in the mediastinum. EBUS is a valuable method in evaluating early endobronchial tumors and peripheral small lung cancers and as well as in mediastinal staging.

• Tuberculosis and Respiratory Diseases
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• 제71권6호
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• pp.408-416
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• 2011

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a technique developed to allow mediastinal staging of lung cancer and also to evaluate intrathoracic lymphadenopathy. In a tuberculosis-endemic area, tuberculosis should be considered as an etiology of mediastinal lymphadenopathy. The aim of this study was to investigate the utility of the routine culture for tuberculosis from specimens of EBUS-TBNA. Methods: We prospectively performed routine culture for tuberculosis from aspiration or core biopsy specimens got from 86 patients who had undergone EBUS-TBNA due to mediastinal lymphadenopathy between March 2010 and March 2011. Results: A total of 135 lymph node aspiration and 118 core biopsy specimens were included in this analysis. We confirmed the malignancy in 62 (72.9%), tuberculosis in 7 (8.1%), sarcoidosis in 7 (8.1%), asperogillosis in 2 (2.3%) and pneumoconiosis in 2 (2.3%) patients. One lung cancer patient had pulmonary tuberculosis coincidentally and 5 patients had unknown lymphadenopathy. The number of positive culture for Mycobacterium tuberculsosis by EBUS-TBNA is 2 (1.5%) from 135 lymph node aspiration specimens and 2 (1.7%) from 118 core biopsy specimens. Out of eight patients confirmed with tuberculosis, only one patient had positive mycobacterial culture of aspiration specimen from EBUS-TBNA without histopathologic diagnosis. Conclusion: These results propose that routine culture for tuberculosis from EBUS-TBNA may not provide additional information for the diagnosis of coincident tuberculous lymphadenitis. However, if there is any possibility of tuberculous lymphadenopathy or pulmonary tuberculosis, it should be considered to perform EBUS-TBNA in patients who have negative sputum AFB smears or no sputum production.

• 대한방사선기술학회지:방사선기술과학
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• 제31권2호
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• pp.141-147
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• 2008

갑상선 질환은 임상에서 흔히 볼 수 있는 내분비계 질환이다. 기존의 FNA (미세침흡인검사)는 갑상선결절 진단에 매우 널리 이용되고 있으나 결절의 크기가 작고 불분명한 경우, 심부에 위치하여 촉진이 어렵거나, 복합 낭종인 경우에는 적절한 표본 획득의 어려움 등의 제한점을 가지고 있다. 이러한 제한점을 최소화하고 검사의 정확성을 높이기 위한 방법의 하나로써 최근에는 US-guided FNA (초음파유도 미세침흡인검사)가 활발히 시행되고 있다. 이에 이 연구에서는 한 대학병원에서 시행되고 있는 US-guided FNA의 결과를 분석하여 표본의 정확성을 파악함으로써 US-guided FNA의 진단적 유용성을 알아보고자 하였다. 갑상선 결절로 US-guided FNA를 시행 받은 364명의 연구대상자중 성별은 여성이 316명(86.8%)으로 월등히 많았으며 연령층은 40대의 비율(51.4%)이 가장 높은 것으로 나타났다. 결절의 위치는 오른쪽이 157명(43.1%), 왼쪽이 130명(35.7%), 협부 9명(2.5%)의 순이었다. 결절의 크기는 1cm 미만인 경우는 38.2%, 1cm 이상인 경우는 61.8%인 것으로 확인되었으며, 결절의 내부 에코 양상은 고형성인 경우가 255명(70.1%)으로 가장 많았으며 낭성은 39명(10.7%), 혼합형인 경우는 19.2%이었다. 병리검사 결과 양성 307명(84.3%), 악성은 20명(5.5%), 악성의심이 4명(1.1%)이었으며, 부적절한 검체는 33명(9.1%)이었다. US-guided FNA는 표본의 적절성과 진단적 정확성을 향상시킬 것으로 기대되며 향후 진단적 정확성과 관련하여 감수성과 특이성, 예측도 등의 지표에 대한 연구들이 보완되어야 할 것으로 사료된다.

• 대한정형외과 초음파학회지
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• 제5권1호
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• pp.41-45
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• 2012

견갑 상 신경의 압박을 초래할 수 있는 많은 질환중에서, 견갑 상 낭종에 의한 압박은 흔치 않으며, 많은 수에서 간과되거나 오진되기도 한다. 저자들은 견갑 상 신경 압박 증상을 초래하고 있는 낭종을 자기공명영상 및 초음파로 확진하였다. 환자의 증상은 견갑 상 신경 중, 하극 신경에만 국한되어 있었다. Neviaser portal과 같은 위치에서 초음파 유도하에 경피적 흡인을 시행하였다. 시술 8주 후 경과에서 재발 소견은 없었으며, 객관적인 기능 평가에서도 호전된 소견을 보였다. 견갑 상 신경의 압박이 의심되는 증상이 있으면, 우선적으로 초음파로 병변을 찾는 것에 주력해야 한다. 낭종의 압박에 의한 증상은 낭종의 단순 제거 혹은 축소로도 증상은 호전되기 때문이다. 하지만, 동반하고 있는 질환 혹은 원인 질환 등이 강력하게 의심될 경우, 추가적인 진단 후에 침습적인 치료를 요할 수도 있다.

• Childhood Kidney Diseases
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• 제11권1호
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• pp.59-64
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• 2007

목적 : 소변 가리기 훈련이 안된 영유아에서 치골상부 방광천자는 오염율이 낮은 최상의 방법(gold standard)이며 초음파 감시하에 시행하여 성공률을 높이고 합병증을 감소시킬 수 있다. 그러나 침습적인 방법으로 여겨져 기피되고 도뇨관 채뇨가 선호되는 경향이 있다. 따라서 저자들은 초음파 감시하 치골상부 방광천자와 도뇨관 채뇨의 성공률, 합병증과 정확도를 비교해 보고자 전향적인 연구를 시행하였다. 방법 : 2003년 6월부터 2004년 8월까지 원인불명의 발열로 이대 목동병원 응급실을 찾아온 영유아중에서 소변을 가리지 못하고 요로감염이 의심되어 소변검사를 시행하게 된 121명을 대상으로 하였다. 일차 조사에서는 초음파 감시하 치골상부 방광천자(32명)와 도뇨관 채뇨(32명)를 무작위로 시행하여 성공률과 합병증을 조사하였고 이차 조사에서는 상기 두 가지 채뇨법을 동시에 시행(57명)하여 도뇨관 채뇨의 정확도를 평가하였다. 성공 기준은 0.5 mL 이상의 소변을 얻은 경우로 하였고 요로감염의 진단은 단일 요로병원균이 $10^5CFU/mL$ 이상 배양된 경우로 정의하였다. 통계분석은 Chi-square test를 이용하였고 P값이 0.05 미만인 경우를 유의한 것으로 판정하였다. 결과 : 성공률은 초음파 감시하 치골상부 방광 천자군이 첫 번째 시도 시 71.9%(23/32), 두 번째 시도 시 25.0%(8/32)로 총 성공률은 96.9% (31/32)였고 도뇨관 채뇨군은 첫 번째 시도 시 90.6% (29/32), 두 번째 시도 시 6.3%(2/32)로 총 성공률 96.9%(31/32)를 보여 두 군간에 유의한 차이는 없었다(P>0.05). 천자된 소변량은 초음파 감시하 치골상부 방광천자군 $7.4{\pm}3.7mL$로 도뇨관 채뇨군의 $4.5{\pm}2.6mL$에 비하여 유의한 차이는 없었다(P>0.05). 합병증은 도뇨관 채뇨군의 53.1%(17/32)에서 배뇨통을 보여 초음파 감시하 치골상부 방광천자군의 0%에 비하여 유의하게 높았다(P<0.001). 이차 조사에서 도뇨관 채뇨의 정확도는 초음파 감시하 치골상부 방광천자에 비해 민감도 59.5%(25/42), 특이도 86.6%(13/15)였고 위양성률 13.3%(2/15), 위음성률 40.5%(17/42) 로 정확도가 낮았다. 결론 : 소변을 가리지 못하는 영유아에서 요로 감염을 진단하기 위해서는 도뇨관 채뇨에 비해 초음파 감시하 치골상부 방광천자가 정확하고 안전한 채뇨법으로 권장되어야 한다고 생각한다.

• Clinical Endoscopy
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• 제57권2호
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• pp.237-245
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• 2024

Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) using Franseen needles is reportedly useful for its high diagnostic yield. This study compared the diagnostic yield and puncturing ability of EUS-TA using 22-gauge cobalt-chromium (CO-Cr) needles with those of stainless-steel Franseen needles in patients with solid pancreatic lesions. Methods: Outcomes were compared between the 22-gauge Co-Cr Franseen needle (December 2019 to November 2020; group C) and stainless-steel needle (November 2020 to May 2022; group S). Results: A total of 155 patients (group C, 75; group S, 80) were eligible. The diagnostic accuracy was 92.0% in group C and 96.3% in group S with no significant intergroup differences (p=0.32). The rate of change in the operator (from training fellows to experts) was 20.0% (15/75) in group C and 7.5% (6/80) in group S. Stainless-steel Franseen needles showed less inter-operator difference than Co-Cr needles (p=0.03). Conclusions: Both Co-Cr and stainless-steel Franseen needles showed high diagnostic ability. Stainless-steel Franseen needles are soft and flexible; therefore, the range of puncture angles can be widely adjusted, making them suitable for training fellows to complete the procedure.

• Clinical Endoscopy
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• 제57권1호
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• pp.89-95
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• 2024

Background/Aims: In stereomicroscopic sample isolation processing, the cutoff value (≥4 mm) of stereomicroscopically visible white cores indicates high diagnostic sensitivity. We aimed to evaluate endoscopic ultrasound-guided tissue acquisition (EUS-TA) using a simplified stereomicroscopic on-site evaluation of upper gastrointestinal subepithelial lesions (SELs). Methods: In this multicenter prospective trial, we performed EUS-TA using a 22-gauge Franseen needle in 34 participants with SELs derived from the upper gastrointestinal muscularis propria, requiring pathological diagnosis. The presence of stereomicroscopically visible white core (SVWC) in each specimen was assessed using stereomicroscopic on-site evaluation. The primary outcome was EUS-TA's diagnostic sensitivity with stereomicroscopic on-site evaluation based on the SVWC cutoff value (≥4 mm) for malignant upper gastrointestinal SELs. Results: The total number of punctures was 68; 61 specimens (89.7%) contained stereomicroscopically visible white cores ≥4 mm in size. The final diagnoses were gastrointestinal stromal tumor, leiomyoma, and schwannoma in 76.5%, 14.7%, and 8.8% of the cases, respectively. The sensitivity of EUS-TA with stereomicroscopic on-site evaluation based on the SVWC cutoff value for malignant SELs was 100%. The per-lesion accuracy of histological diagnosis reached the highest level (100%) at the second puncture. Conclusions: Stereomicroscopic on-site evaluation showed high diagnostic sensitivity and could be a new method for diagnosing upper gastrointestinal SELs using EUS-TA.

• Clinical Endoscopy
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• 제57권3호
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• pp.384-392
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• 2024

Background/Aims: Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is a standard diagnostic method for biliary tract cancer (BTC), and samples obtained in this manner may be used for comprehensive genomic profiling (CGP). This study evaluated the utility of EUS-TA for CGP in a clinical setting and determined the factors associated with the adequacy of CGP in patients with BTC. Methods: CGP was attempted for 105 samples from 94 patients with BTC at the Aichi Cancer Center, Japan, from October 2019 to April 2022. Results: Overall, 77.1% (81/105) of the samples were adequate for CGP. For 22-G or 19-G fine-needle biopsy (FNB), the sample adequacy was 85.7% (36/42), which was similar to that of surgical specimens (94%, p=0.45). Univariate analysis revealed that 22-G or larger FNB needle usage (86%, p=0.003), the target primary lesions (88%, p=0.015), a target size ≥30 mm (100%, p=0.0013), and number of punctures (90%, p=0.016) were significantly positively associated with CGP sample adequacy. Conclusions: EUS-TA is useful for CGP tissue sampling in patients with BTC. In particular, the use of 22-G or larger FNB needles may allow for specimen adequacy comparable to that of surgical specimens.

• Asian Pacific Journal of Cancer Prevention
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• 제15권10호
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• pp.4169-4173
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• 2014

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is highly accurate in diagnosing mediastinal lymphadenopathies of lung cancer and benign disorders. However, the utility of EBUS-TBNA in the diagnosis of mediastinal lymphomas is unclear. The aim of this study was to determine the diagnostic value of EBUS-TBNA in patients with suspected lymphoma. Materials and Methods: Sixty-eight patients with isolated mediastinal lymphadenopathy and suspected of lymphoma were included in the study. EBUS-TBNA was performed on outpatients under moderate sedation. The sensitivity, specificity, negative predictive value and diagnostic accuracy of EBUS-TBNA were calculated. Results: Sixty-four patients were diagnosed by EBUS-TBNA, but four patients with non-diagnostic EBUS-TBNA required surgical procedures. Thirty-five (51.5%) patients had sarcoidosis, six (8.8%) had reactive lymphadenopathy, nine (13.3%) had tuberculosis, one (1.5%) had squamous cell carcinoma, two (2.9%) had sarcoma and fifteen (22%) had lymphoma (follicular center cell, large B-cell primary, and Hodgkin lymphomas in three, two, and ten, respectively). Of the 15 lymphoma patients, thirteen were diagnosed by EBUS and two by thoracotomy and mediastinoscopy. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of lymphoma were calculated as 86.7%, 100%, 96.4%, and 97%, respectively. Conclusions: EBUS-TBNA can be employed in the diagnosis of mediastinal lymphoma, instead of more invasive surgical procedures.

• Tuberculosis and Respiratory Diseases
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• 제74권4호
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• pp.177-180
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• 2013

We report a 54-year-old woman who presented with a well-defined, homogeneous, and non-enhancing mass in the retrobronchial region of the bronchus intermedius. The patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histological confirmation. Serous fluid was aspirated by EBUS-TBNA. Cytological examination identified an acellular smear with negative microbiological cultures. The patient was finally diagnosed with bronchogenic cysts by chest computed tomography (CT) and EBUS-TBNA findings. However, 1 week after EBUS-TBNA, the patient developed bronchogenic cyst rupture and pneumonia. Empirical antibiotics were administered, and pneumonia from the bronchogenic cyst rupture had resolved on follow-up chest CT. To our knowledge, this is the first reported case of pneumonia from bronchogenic cyst rupture after EBUS-TBNA.