Prognostic Factors and Scoring Systems for Non-Small Cell Lung Cancer Patients Harboring Brain Metastases Treated with Gamma Knife Radiosurgery

엄중섭,이민기,조은정,백동훈,이경남,신경화,김미현,이광하,김기욱,박혜경,김윤성,박순규,차승헌 대한결핵및호흡기학회 2012 Tuberculosis and Respiratory Diseases Vol.72 No.1

Background: The survival of non-small cell lung cancer (NSCLC) patients with brain metastases is reported to be 3∼6 months even with aggressive treatment. Some patients have very short survival after aggressive treatment and reliable prognostic scoring systems for patients with cancer have a strong correlation with outcome, often supporting decisionMethods: A total of one hundred twenty two NSCLC patients with brain metastases who received gamma knife radiosurgery (GKRS) were analyzed. Survival analysis was calculated in all patients for thirteen available prognostic factors and four prognostic scoring systems: score index for radiosurgery (SIR), recursive partitioning analysis (RPA), graded prognostic assessment (GPA), and basic score for brain metastases (BSBM). making and treatment recommendations. Results: Age, Karnofsky performance status, largest brain lesion volume, systemic chemotherapy, primary tumor control, and medication of epidermal growth factor receptor tyrosine kinase inhibitor were statistically independent prognostic factors for survival. A multivariate model of SIR and RPA identified significant differences between each group of scores. We found that three-tiered indices such as SIR and RPA are more useful than four-tiered scoring systems (GPA and BSBM). Conclusion: There is little value of RPA class III (most unfavorable group) for the same results of 6-month and 1-year survival rate. Thus, SIR is the most useful index to sort out patients with poorer prognosis. Further prospective trials should be performed to develop a new molecular- and gene-based prognostic index model.

TP-60:Thematic Poster ; Fibrotic Airway Stenosis Following Radiotherapy in Patients with Adenoid Cystic Carcinoma

엄중섭,김호중,전경만,엄상원,고원중,서지영,정만표,권오정 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-

Purpose: Radiotherapy (RT) is usually administered to the central airway in patients with unresectable adenoid cystic carcinoma (ACC). The purpose of this study was to investigate the incidence, characteristics, and outcomes of bronchoscopic intervention in patients with ACC who developed fibrotic airway stenosis following RT. Methods and Materials: Forty-seven patients with ACC, who underwent RT of the tracheobronchial tree from 1995 to 2011, were reviewed retrospectively. Fibrotic airway stenoses were diagnosed using three-dimensional computed tomography, flexible bronchoscopy, or both. Results: Eleven (23%) of the 47 patients with ACC suffered fibrotic airway stenosis following RT and received bronchoscopic intervention. Bronchoscopic intervention provided both immediate symptomatic relief and improvement of lung function in all patients, and no procedure-related death or immediate major complication such as pneumomediastinum, pneumothorax, pneumonia, or massive bleeding was observed. Insertion of a straight silicone stent was required in 10 patients (91%), and 4 (36%) eventually received Y-shaped silicone stents. The patients could not remove the silicone stent once they were implanted; however, the stents were well-tolerated for a prolonged period in all patients. Conclusions: The incidence of fibrotic airway stenosis following RT in patients with ACC was relatively high. In addition, bronchoscopic intervention, including silicone airway stenting, was a safe and useful method for treating RT-induced fibrotic airway stenosis in patients with ACC. Purpose: Radiotherapy (RT) is usually administered to the central airway in patients with unresectable adenoid cystic carcinoma (ACC). The purpose of this study was to investigate the incidence, characteristics, and outcomes of bronchoscopic intervention in patients with ACC who developed fibrotic airway stenosis following RT. Methods and Materials: Forty-seven patients with ACC, who underwent RT of the tracheobronchial tree from 1995 to 2011, were reviewed retrospectively. Fibrotic airway stenoses were diagnosed using three-dimensional computed tomography, flexible bronchoscopy, or both. Results: Eleven (23%) of the 47 patients with ACC suffered fibrotic airway stenosis following RT and received bronchoscopic intervention. Bronchoscopic intervention provided both immediate symptomatic relief and improvement of lung function in all patients, and no procedure-related death or immediate major complication such as pneumomediastinum, pneumothorax, pneumonia, or massive bleeding was observed. Insertion of a straight silicone stent was required in 10 patients (91%), and 4 (36%) eventually received Y-shaped silicone stents. The patients could not remove the silicone stent once they were implanted; however, the stents were well-tolerated for a prolonged period in all patients. Conclusions: The incidence of fibrotic airway stenosis following RT in patients with ACC was relatively high. In addition, bronchoscopic intervention, including silicone airway stenting, was a safe and useful method for treating RT-induced fibrotic airway stenosis in patients with ACC.

Timing of Silicone Stent Removal in Patients with Post-tuberculosis Bronchial Stenosis

엄중섭,김호중,전경만,엄상원,고원중,서지영,정만표,권오정 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Objectives: Traditionally, stent removal was recommended at 12-18 months after stent insertion in patients with post-tuberculosis bronchial stenosis (PTBS). From our 6-year experience, timing of stent removal in PTBS patients and its clinical impacts were analyzed. Methods: Total 43 PTBS patients who attempted elective stent removal between January 2004 and December 2009 were retrospectively reviewed. Period of stable state before stent removal (PSS) was defined as the interval from the last intervention before stent removal to the stent removal. For analysis, patients were grouped according to the interval from stent insertion to removal (ISR): early removal group as ISR <1 year and late removal group as ISR ≥1 year. Results: Forty-five additional interventions before stent removal were performed in 25 patients. Most of additional interventions (82.2%) were conducted within 6 months after previous intervention. Restenosis after stent removal occurred in 9 patients (20.9%) and all were developed within 4 months after stent removal. In subgroup analysis, late removal group had more frequent atelectasis on initial chest radiographs (p=0.019) and longer PSS (p<0.001). Although there were several differences between two groups, restenosis rates after stent removal were not different (p=0.001). Conclusion: Interventional pulmonologists should consider atelectasis on initial chest radiographs and PSS before silicone stent removal in PTTS patients.

F-53 Feasibility of low-dose three-dimensional CT for peripheral bronchoscopy

엄중섭,이지원,목정하,정연주,김인수,김원영,조은정,김미현,이광하,김기욱,박혜경,이민기 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Introduction: Reconstructed thin-section CT is essential to identify small peripheral bronchi during peripheral bronchoscopy using radial probe endobronchial ultrasound. We performed a retrospective study with a prospectively collected database to identify the optimal radiation dose for reconstructed thin section CT for peripaheral bronchoscopy. Methods: A total of 80 patients with peripheral lung lesions underwent three-dimensional CT (both standard-dose CT as a reference and low-dose CT). Subjects were randomly assigned to one of four groups: group 1 = 120 kVp, 25 mAs; group 2 = 100 kVp, 15 mAs; group 3 = 120 kVp, 5 mAs and group 4 = 100 kVp, 5 mAs. Two radiologists evaluated the effective dose, image noise, bronchus sign and wall thickness of the peripheral airway. Results: The effective doses were significantly different among the four groups (mean effective dose, 1.19 ± 0.08, 0.43 ± 0.05, 0.29 ± 0.02 and 0.15 ± 0.01 mSv for groups 1-4, respectively; P < 0.001). The degree of image noise in group 4 was significantly higher than those in the other groups (P < 0.001). The correlation of the bronchus sign between low- and standard- dose CT in group 4 was significantly lower than in the other groups (100%, 100%, 95% and 55% for groups 1-4, respectively; P < 0.001). The differences in peripheral airway wall thickness in group 4 were significantly higher than those in the other groups (P = 0.014). Conclusions: Our results indicated that low-dose three-dimensional CT with an effective dose of > 0.15 mSv (effective dose of group 4) is feasible for peripheral bronchoscopy.

F-61 Managing malignant pleural effusions with pleurodesis using mistletoe extract via a spray catheter during semi-rigid pleuroscopy

엄중섭,목정하,이민기,김미현,이광하,김기욱,박혜경 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.0

Background: Using a spray catheter, a liquid sclerosant, such as mistletoe extract, can be sprayed evenly into the pleural cavity for pleurodesis during semi-rigid pleuroscopy. We conducted a retrospective study of a prospectively collected database to identify the usefulness of pleurodesis using mistletoe extract via a spray catheter during semi-rigid pleuroscopy for symptomatic malignant pleural effusion (MPE). Methods: From October 2015 to September 2016, all consecutive patients with symptomatic MPE who underwent semi-rigid pleuroscopy were registered prospectively. The response was evaluated with chest X-rays or computed tomography 4 weeks after pleurodesis. Results: The study included 43 patients who underwent pleurodesis using mistletoe extract via a spray catheter. Complete and partial responses were seen in 21 (49%) and 19 (44%) patients, respectively. The median duration of chest tube placement after pleurodesis was 7 (IQR, 6-8) days in the 40 patients with complete or partial responses. In 4 weeks after semi-rigid pleuroscopy, there were no cases of severe hemorrhage, empyema formation, respiratory failure, or procedure-related mortality in the study subjects. Conclusion: During semi-rigid pleuroscopy, pleurodesis with mistletoe extract via a spray catheter is a safe, effective procedure for managing symptomatic MPE.

말초 폐병변의 진단: 방사탐색자 기관지내 초음파를 이용한 기관지경유 폐생검

엄중섭 대한의사협회 2023 대한의사협회지 Vol.66 No.3

Background: Radial probe endobronchial ultrasound (RP-EBUS) has been used in the diagnosis of peripheral lung lesions (PLLs). We reviewed the traditional modality of transbronchial biopsy using RP-EBUS as well as recent developments in improving the diagnostic yield. Current Concepts: Until now, the forceps biopsy of PLLs has played a key role in acquiring tissue samples during the RP-EBUS procedures. Forceps biopsy is a safe and minimally invasive procedure; however, its diagnostic yield was reported to be around 70%, which is significantly lower than that of percutaneous needle aspiration or biopsy. So far, various studies have been conducted to improve the diagnostic yield of the RP-EBUS procedure. The combination of novel navigation systems, such as virtual or electromagnetic navigation bronchoscopies, for locating PLLs in the complex bronchial tree has increased the diagnostic yield of the RP-EBUS procedure. Moreover, newly developed ancillary devices, such as the PeriView FLEX needle or cryobiopsy, as well as traditional modalities such as the guide sheath and brushing cytology, can improve the outcomes of the RP-EBUS procedures. Concerning the bronchoscope size, it has been confirmed that a 3 mm-diameter ultrathin bronchoscope has a higher diagnostic yield than a 4 mm-diameter thin bronchoscope. Discussion and Conclusion: RP-EBUS is a safe and useful method to diagnose PLLs. When traditional and novel modalities are appropriately combined, the diagnostic yield can be increased.

Lack of Correlation between Tracheal Index and Lung Function Parameters in Patients with Chronic Obstructive Pulmonary Disease

엄중섭,박혜윤,임소연,이경종,전경만,엄상원,고원중,서지영,정만표,김호중,권오정 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Objectives: It is well-known that saber sheath tracheal (SST) morphology is related to COPD and previous studies showed the positive correlation between tracheal index (TI) and forced expiratory volume at 1 second (FEV1). However, few studies evaluated the association between lung volume tests and TI measured by chest X-ray (CXR) or chest computed tomography (CT). Methods: A retrospective study was conducted with 43 COPD patients and 59 controls who had CT, CXR and lung function tests including spirometry and lung volume measurement. Tracheal parameter was used as TI, a ratio of tracheal transverse diameter to anteroposterior diameter. TI was measured at 1cm above the aortic arch. SST was defined as when the TI was less than 2/3. Results: In COPD group, TI value was significantly lower than one in the control group on CT scan, while TI measured on CXR were similar in two groups. Furthermore, SST defined from CT scan was significantly frequent in COPD patient (16.3% vs. 3.4%; p=0.023). However, TI was not related to any lung function parameters in COPD patients. Conclusion: Current study showed that SST was more frequent and TI was lower in COPD patient, while TI was not correlated with lung function including lung volume tests.

Feasibility of low-dose chest CT for virtual bronchoscopy navigation in a porcine model

엄중섭,이지원,김인수,안효영,조은정,목정하,김미현,김기욱,이광하,박혜경,이민기 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

Background: Virtual bronchoscopy navigation (VBN) is widely used for the histological examination of lung nodules. However, little is known about the optimal radiation dose of computed tomography (CT) for the operation of VBN systems. Therefore, we evaluated the feasibility of low-dose CT (LDCT) for VBN in an animal study. Methods: Five live pigs underwent standard-dose CT (120 kVp, 90 mAs) as a reference and four different LDCT protocols: LDCT 1, 120 kVp, 55 mAs; LDCT 2, 120 kVp, 20 mAs; LDCT 3, 100 kVp, 30 mAs; and LDCT 4, 100 kVp, 20 mAs. To operate the VBN, 10 mm virtual targets were created in the central and peripheral bronchi, where the bronchus diameter was less than 3 mm, in each of the six lobes of the five pigs. Results: The mean effective doses significantly differed among the four LDCTs (17.1, 6.3, 5.7 and 3.8 mSv for LDCTs 1-4, respectively; P<0.001). There were significant differences in the accuracy of VBN between low- and standard-dose CT in both central (100%, 93%, 87%, and 73% for LDCTs 1-4, respectively; P<0.001) and peripheral (90%, 77%, 50%, and 30% for LDCTs 1-4, respectively; P<0.001) virtual targets. The areas under the ROC curves for predicting accurate VBN with LDCT were 0.71 (P<0.001) and 0.72 (P<0.001) for central and peripheral virtual targets, respectively. Conclusions: Low-dose CT is feasible for VBN.

내시경 점막하 박리술로 제거된 위의 중복 낭종

엄중섭 ( Jung Seop Eom ),김광하 ( Gwang Ha Kim ),송근암 ( Geun Am Song ),백동훈 ( Dong Hoon Baek ),류광덕 ( Kwang Duck Ryu ),이경남 ( Kyung Nam Lee ),박도윤 ( Do Youn Park ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.6

Duplication cysts are uncommon congenital malformations that may occur anywhere throughout the alimentary tract. The stomach is an extremely rare site of occurrence. Here, we report a case of gastric duplication cyst initially presenting with a gastric submucosal tumor. A 28-year-old man complained of dyspepsia lasting 1 year and upper endoscopy revealed an ellipsoid submucosal tumor at the greater curvature of the antrum. We intended to use the injection-and-cut technique: however, after saline injection, the lesion was dented and impossible to grasp with a snare. Therefore, we decided to perform endoscopic submucosal dissection and removed the tumor without complication. Histopathology revealed a 0.6×0.6 cm-sized duplication cyst, and there has been no recurrence in 2 years. (Korean J Gastroenterol 2011;58:346-349)

New-Onset Malignant Pleural Effusion after Abscess Formation of a Subcarinal Lymph Node Associated with Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

정선미,엄중섭,김민지,조정수,이기원,김아롱,김정미,박철홍,박종만,송병구 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.77 No.4

We present a case of an unusual infectious complication of a ruptured mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which led to malignant pleural effusion in a patient with stage IIIA non-small-cell lung cancer. EBUS-TBNA was performed in a 48-year-old previously healthy male, and a mediastinal abscess developed at 4 days post-procedure. Video-assisted thoracoscopic surgery was performed for debridement and drainage, and the intraoperative findings revealed a large volume pleural effusion that was not detected on the initial radiographic evaluation. Malignant cells were unexpectedly detected in the aspirated pleural fluid, which was possibly due to increased pleural permeability and transport of malignant cells originating in a ruptured subcarinal lymph node from the mediastinum to the pleural space. Hence, the patient was confirmed to have squamous cell lung carcinoma with malignant pleural effusion and his TNM staging was changed from stage IIIA to IV.