Predicting malignancy risk of lung nodules diagnosed as indeterminate on radial endobronchial ultrasound guided biopsy

( Sungmin Zo ),( Kyungjong Lee ),( Sook-young Woo ),( Seonwoo Kim ),( Ho Yun Lee ),( Byeong-ho Jeong ),( Sang-won Um ),( Hojoong Kim ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Advancement of technology has improved diagnostic sensitivity of radial endobronchial ultrasound (EBUS). Also, image characteristics of radial EBUS provide additional information of risk for malignancy of a lung nodule. However, when indeterminate radial EBUS guided biopsy results, such as atypical cell, fibrosis and inflammation are reported, there is no consensus among doctors whether to consider re-biopsy or surgery, or to observe with follow up. In this study, first, we identified malignancy associated risk factors from radial EBUS image findings, clinical and radiological factors. Second, based on identified risk factors, we constructed a nomogram to predict the risk of malignancy in indeterminate biopsy results. Methods: This retrospective designed study included 157 patients, diagnosed as indeterminate with radial EBUS guided biopsy from January 2017 to December 2018. Medical records, Chest Computed tomography (CT), radial EBUS images and final diagnosis results were reviewed. Patients were randomly divided into training and validation sets. The factors related to malignancy were identified through logistic regression analysis, and nomogram was constructed using the training set and subsequently applied to the validation set. Results: Through univariate and multivariate analysis, upper lobe location, spiculation, presence of satellite nodules, echogenicity, presence of dot or linear arc and patency of vessels and bronchus were identified as predictors. The nomogram was constructed based on predictors. The area under the receiver operating characteristic curve (AUC) value of constructed nomogram was 0.858 (0.786-0.930) using radiological factors, and improved to 0.952 (0.914-0.990) when radial EBUS factors was added. The calibration curve showed optimal agreement between the malignant probability as predicted by nomogram and the actual probability. Conclusions: The nomogram constructed in this study could be utilized in predicting the probability of malignancy in lung nodules diagnosed as indeterminate on radial EBUS, and may help in selecting patients who are at high risk for malignancy.

Comparison of Clinical Characteristics and Prognosis of Incidentally Detected and Screening Detected Lung Cancers

( Sungmin Zo ),( Sun Hye Shin ),( Byeong ),( Ho Jeong ),( Kyungjong Lee ),( Hojoong Kim ),( O Jung Kwon ),( Sang Won Um ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background With the increasing use of the computed tomography (CT) scans, the clinicians more commonly encounter incidentally detected pulmonary nodules, parts of which are finally diagnosed as primary lung cancer during follow-up. The clinical characteristics of incidentally detected lung cancers (IDLCs) have not been well known in South Korea. In this study, we compared the clinical characteristics and prognosis of IDLC and screening detected lung cancer (SDLC). Methods This retrospective study included the subjects with pulmonary nodules (<3cm) at the baseline CT scans, which were pathologically confirmed as primary lung cancer in year 2015. The study population was classified as IDLC and SDLC according to the setting of the first pulmonary nodule detection. The symptomatic subjects at the time of the pulmonary nodule detection were excluded. Clinicoradiologic characteristics and overall survival (OS) rates were compared between the IDLC and SDLC groups. Results Among 553 study subjects, 209 (37.8%) IDLCs and 344 (62.2%) SDLCs were identified. IDLCs were most commonly discovered by the surveillance of other malignancy (36.4%) followed by the evaluation of benign diseases (32.1%). The IDLC group was older and had more smokers compared with the SDLC group. Adenocarcinomas were more commonly detected in the SDLC group (84.6%) than in the ILDC group (78.0%, P<0.001). The rates of pulmonary resection in the IDLC and SDLC groups were 86.1% and 87.8%, respectively (P=0.662). The 5-year OS rates of the IDLC group (80.9%) was similar to that of the SDLC group (84.9%, P=0.150). Conclusion Among non-symptomatic lung cancer patients, the proportion of IDLC was about 38% in our cohort. The IDLC group was associated with old age, smokers, history of other malignancy, and non-adenocarcinoma histology. However, the prognosis of the IDLC group was not inferior to the SDLC group.

Impact of Antibiotics Maintenance Period for Redevelopment of Mycobacterium Avium Complex Pulmonary Disease after Microbiological Cure

( Sungmin Zo ),( Hojoong Kim ),( O Jung Kwon ),( Jhun Byung Woo ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Limited data are available regarding the maintenance period of antibiotics on the redevelopment of Mycobacterium avium complex-pulmonary disease (MAC-PD) after achieving microbiological cure. Methods This retrospective study included 631 patients who achieved microbiological cure after diagnosis of MAC-PD between 1994 and 2021. Data on the antibiotic maintenance period, defined as the time between culture conversion and treatment completion, were collected and divided into two groups based on a cutoff of 12 months. Redevelopment, the subsequent diagnosis of nontuberculous mycobacteria (NTM)-PD regardless of the causative organism after microbiological cure, was investigated as the outcome. Factors associated with outcome were analyzed after adjusting for disease severity using the body mass index, age, cavity, erythrocyte sedimentation rate, and sex (BACES) scoring system. Results A total of 205 (32%) patients showed redevelopment, with a median maintenance period after culture conversion of 14.0 months (interquartile range 12.0-19.0 months). BACES severity, comorbidities, and etiology were comparable between the redevelopment group and those with persistent microbiological cure except for a higher proportion of nodular bronchiectatic form (87% vs. 80%, respectively, p = 0.033) and longer maintenance period (15.0 vs. 14.0 months, respectively, p < 0.001) in the redevelopment group compared to the persistent microbiological cure group. Cumulative rate of redevelopment according to maintenance period did not differ between the ≥ 12 months and < 12 months groups in the total patient population or in subgroups sorted according to BACES severity or phenotype. No association between maintenance period and redevelopment was identified in univariate and multivariate models adjusted for BACES severity and phenotype. Conclusion Maintenance period had no effect on redevelopment regardless of adjustment of BACES severity or phenotype, suggesting that extension of the maintenance period may not reduce the redevelopment rate after achieving microbiological cure, and further research is required to optimize the maintenance period.

The Prevalence of and Factors Associated with Influenza Vaccination in Patients with Asthma in Korea

( Sang Hyuk Kim ),( Sungmin Zo ),( Hwasik Jung ),( Saerom Kim ),( Ho Joo Yoon ),( Jang Won Sohn ),( Tae-hyung Kim ),( Sang-heon Kim ),( Ji-yong Moon ),( Dong Won Park ),( Tai Sun Park ),( Hye Yun Park 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Patients with asthma are at high risk of hospitalization and death from influenza infection, which Results in an additional burden on the medical system. However, despite the crucial role of influenza vaccination in preventing influenza infection and its complication, detailed epidemiologic data regarding influenza vaccination among patients with asthma is lacking. This study aimed to investigate the rate of influenza vaccination and factors associated with the vaccination in patients with asthma using nationally representative survey data. Methods Among 72,843 participants of the Korea National Health and Nutrition Examination Survey between 2010 and 2019, 760 patients with self-reported physician-diagnosed asthma were included in this study. The outcome was the influenza vaccination rate assessed by questionnaire. Logistic regression analysis was performed to evaluate factors associated with not being vaccinated in patients with asthma. Results The overall influenza vaccination rate was 63.7% in patients with asthma and there was no significant change in the vaccination rate (range 58.7%-70.0%) during the study period. In multivariable logistic regression analysis, younger age (adjusted odds ratio [aOR] 1.11, 95% confidence interval [CI] 1.07-1.16, p < 0.001), lower income (aOR 2.76, 95% CI 0.77-3.80, p = 0.040), and the presence of respiratory symptoms (aOR 2.56, 95% CI 1.22-5.36, p = 0.012) were associated with the increased odds of being unvaccinated for influenza. Conclusion The vaccination rate in patients with asthma was stable, ranging from approximately 60% to 70% between 2010 and 2019 in Korea. As patients with younger age, lower income, or respiratory symptoms might be non-adherent to influenza vaccination, more attention is needed in these patients to increase the influenza vaccination rate. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Science, Information and Communications Technologies (MSIT) (NRF-2020R1F1A1070468 and NRF-2021M3E5D1A01015176).

Clinical characteristics according to CAT score level in COPD patients: cross-sectional study

( Hyun-il Gil ),( Sungmin Zo ),( Jiyeon Kang ),( Noeul Kang ),( Hyunkyu Cho ),( Yeonseok Choi ),( Junsu Choe ),( Hye Yun Park ),( Sun Hye Shin ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Purpose: Chronic obstructive pulmonary disease (COPD) assessment test (CAT) is widely used to measure quality of life in COPD. This tool is also one of determinants of COPD severity to guide COPD management. This study aimed to investigate the clinical characteristics of COPD patients according to CAT score level measured at baseline. Method: COPD patients with CAT score measured at baseline were retrospectively identified from COPD registry of Samsung Medical Center between February 2016 and April 2019. COPD was defined as post-bronchodilator forced expiratory volume in 1 second (FEV1)/ forced vital capacity (FVC) < 0.7 and age ≥ 40 years. Patients were grouped into quintiles of CAT score level. Baseline clinical characteristics and lung function parameters were compared according to CAT score quintiles. Result: A total of 725 patients were included and median (interquartile range [IQR]) CAT score was 17 (11 - 24). Median (IQR) of each CAT score quintile were 6 (4 - 8), 13 (11 - 14), 18 (17 - 19), 23 (22 - 25), and 30 (28 - 34). Age, sex, smoking history and Charlson comorbidity index score did not differ according to CAT score quintiles. Dyspnea of modified medical research council (mMRC) grade ≥ 2 and the previous history of any exacerbation significantly increased across CAT score quintiles, while post bronchodilator FEV1 and diffusing capacity of lung for carbon monoxide (DLco) significantly decreased across CAT score quintiles. Conclusion: Among the clinical characteristics of COPD patients, dyspnea, previous history of any exacerbation, post bronchodilator FEV1 and DLco were significantly associated with CAT score level.

In Vitro Activity of Benzimidazole (SPR719) Against Clinical Isolates of Nontuberculous Mycobacteria With and Without Clarithromycin or Amikacin Resistance

Kim Dae Hun,Zo Sungmin,Kim Su-Young,Jhun Byung Woo 대한진단검사의학회 2024 Annals of Laboratory Medicine Vol.44 No.1

Limited data are available regarding the in vitro activity of SPR719, a derivative of benzimidazole, against diverse nontuberculous mycobacteria (NTM) species. We investigated the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of SPR719 against clinical NTM isolates, including clarithromycin- and amikacin-resistant strains. NTM isolates were obtained from patients with NTM-pulmonary disease caused by various NTM species, including Mycobacterium avium complex, M. abscessus (subspecies abscessus and massiliense), M. kansasii, and M. fortuitum. Regardless of clarithromycin or amikacin resistance, the MIC and MBC values of SPR719 were comparable among these major pathogenic NTM species. In over 70% of the isolates, the MIC values were ≤2 μg/mL with MBC values of ≤4 μg/mL. The MIC and MBC values of M. kansasii were relatively lower than those of the other species with little difference between them, demonstrating the bactericidal properties of SPR719. The in vitro activity of SPR719 against major clinical NTM species suggests that SPR719 can serve as a novel treatment option for NTM-pulmonary disease.

Clinical Implication in COPD Assessment Test Score Changes among Newly Diagnosed COPD Patients Treated with Bronchodilators

( Bo-guen Kim ),( Hye Yun Park ),( Sun Hye Shin ),( Hyun-il Gil ),( Sungmin Zo ),( Ju Yeun Song ),( Chaiyoung Lee ),( Danbee Kang ),( Juhee Cho ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Backgroud The chronic obstructive pulmonary disease (COPD) assessment test (CAT) measures the health status of patients with COPD. We investigated change of individual CAT scores after short-term bronchodilator therapy and evaluate their impact on lung function, mMRC, and exacerbations among treatment-naive patients with COPD. Patients and Methods Data from 148 patients newly diagnosed with COPD between February 2016 and April 2020 were retrospectively analyzed. We compared the CAT score, modified Medical Research Council dyspnea grade, and forced expiratory volume in 1 s (FEV1) before and after bronchodilator therapy for a median of 5.8 (range: 5.1-6.5) months. We analyzed the change trends using generalized estimating equations. Results The mean patient age was 70.9 years, and 92.6% of them were men. Most patients (72.3%) had a Global Initiative for Chronic Obstructive Lung Disease grade II. The patients were divided into two groups: CAT score improved (n=69) and not improved group (n=79). Among the CAT items, phlegm (adjusted difference: -0.22 [95% confidence interval: -0.48, -0.002]), chest tightness (-0.30 [-0.56, -0.05]), and breathlessness scores (-0.45 [-0.66, -0.23]) significantly improved after bronchodilator therapy. While the FEV1 significantly improved in both groups, development of moderate-to-severe exacerbations during follow-up was significantly lesser (2.9% vs. 17.7%, p=0.004) in the CAT score improved group than in the not improved group. Moreover, the patients with mMRC ≥ 2 significantly decreased (OR, 0.36 [0.20, 0.64]) only in the CAT score improved group. Conclusion Despite the significant increase in the FEV1 after bronchodilator therapy, less than half of patients achieved meaningful improvement in health status with improvement of mostly respiratory items of CAT and were at reduced risk of exacerbation. Therefore, tracking CAT total score with each items changes along with lung function assessment at each visit is necessary.