The role of Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in lymphoma patients

양범희,임준혁,신선혜,정병호,엄상원,김호중,이경종 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

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. So, in this study, we evaluate to determine the diagnositic accuracy of EBUS-TBNA in patients with lymphoma and the factors affecting the diagnosis of lymphoma. Methods: Between May 2009 and May 2017, EBUS-TBNA database was analyzed retrospectively. Results: A total of 131 lymph nodes were evaluated in 65 patients pathologically diagnosed lymphoma. The diagnosis rates to subtype of lymphoma by EBUS were 57%(37/65) in patients and 54% in lymph nodes (71/131). There was no significant difference in age, staging, and type of lymphoma between the diagnosed lymphoma patients and non-diagnosed lymphoma patients. However, lymph node diagnosed with lymphoma were statistically significantly larger in lymph node size (p=0.021) and higher in SUV max (p<0.001). Multivariate analyses revealed that larger lymph node size (adjusted odds ratio [OR]=2.21, 95% confidence interval [CI]=1.12-3.48), and higher SUV max diseases (adjusted ORs=4.28, 95% CI=1.65-7.28), were associated with diagnosis rate. Conclusion: The diagnosis rate of subtyping lymphoma on the basis of EBUS was 57%. If the SUVmax value of the lymph nodes is high or size of lymph node is large, a diagnosis of lymphoma by EBUS-TBNA might be attempted.

F-44 Clinical presentation and treatment outcome of 67 patients with pulmonary cryptococcosis

양범희,이현,신선혜,김민영,정병호,권오정,이경수,김호중 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Despite the indolent infection of Pulmonary cryptococcosis (PC), the natural course and adequate treatment of this disease have not been well documented. We reviewed 67 patients with pathologically proven PC between Jan 2000 and Dec 2016. Clinical presentation and treatment outcome were evaluated according to immune status. We further compared the treatment outcome between the patients who underwent surgical resection alone and those who received antibiotics following surgical resection. Of the 67 patients, 79% were immunocompetent. Compared with immunocompetent patients, immunocompromised patients were more likely to have respiratory symptoms (93% vs. 53%, p=0.006). Whereas surgical resection(46%) was most widely used in immunocompetent patients, antibiotic alone (86%) was most widely used in immunocompromised patients. During a median follow-up of 42.4 months, disease progression was more frequent in immunocompromised patients versus immunocompetent patients (21% vs. 2%, p=0.021). Of the 25 patients who underwent surgical treatment, 9 patients additionally received antibiotic treatment afterwards. There was no significant difference in recurrence between the patients who underwent surgical resection alone and those who additionally received antibiotic treatment(p = 0.999). In conclusion, the clinical outcome of PC was worse in immunocompromised patients than in immunocompetent patients. There was no additional role of antibiotic treatment for the prevention of recurrence of PC after complete surgical resection.

Risk of Coronavirus Disease 2019 Occurrence, Severe Presentation, and Mortality in Patients with Lung Cancer

양범희,최하영,이선경,정승준,여유미,신윤미,박동원,박태선,문지용,김태형,심윤수,윤호주,손장원,이현,김상헌 대한암학회 2021 Cancer Research and Treatment Vol.53 No.3

Purpose This study aimed to analyze whether patients with lung cancer have a higher susceptibility of coronavirus disease 2019 (COVID-19), severe presentation, and higher mortality than those without lung cancer. Materials and Methods A nationwide cohort of confirmed COVID-19 (n=8,070) between January 1, 2020, and May 30, 2020, and a 1:15 age-, sex-, and residence-matched cohort (n=121,050) were constructed. A nested case-control study was performed to compare the proportion of patients with lung cancer between the COVID-19 cohort and the matched cohort. Results The proportion of patients with lung cancer was significantly higher in the COVID-19 cohort (0.5% [37/8,070]) than in the matched cohort (0.3% [325/121,050]) (p=0.002). The adjusted odds ratio [OR] of having lung cancer was significantly higher in the COVID-19 cohort than in the matched cohort (adjusted OR, 1.51; 95% confidence interval [CI], 1.05 to 2.10). Among patients in the COVID-19 cohort, compared to patients without lung cancer, those with lung cancer were more likely to have severe COVID-19 (54.1% vs. 13.2%, p < 0.001), including mortality (18.9% vs. 2.8%, p < 0.001). The adjusted OR for the occurrence of severe COVID-19 in patients with lung cancer relative to those without lung cancer was 2.24 (95% CI, 1.08 to 4.74). Conclusion The risk of COVID-19 occurrence and severe presentation, including mortality, may be higher in patients with lung cancer than in those without lung cancer.

Impact of Bronchiectasis on Postoperative Pulmonary Complications after Extra-Pulmonary Surgery in Patients with Airflow Limitation

양범희,최하영,정승준,Beomsu Shin,이현,박혜윤 대한의학회 2020 Journal of Korean medical science Vol.35 No.13

The impact of bronchiectasis on the occurrence of postoperative pulmonary complications (PPC) after extra-pulmonary surgery in patients with airflow limitation is not well elucidated. A retrospective analysis of 437 patients with airflow limitations, including 62 patients with bronchiectasis, was conducted. The analysis revealed that bronchiectasis was associated with increased PPC (adjusted odds ratio [aOR], 2.73; P = 0.001), which was especially significant in patients who did not use bronchodilators (aOR, 3.24; P = 0.002). Our study indicates that bronchiectasis is associated with an increased risk of PPC following extra-pulmonary surgery in patients with airflow limitation, and bronchodilators may prevent PPC in these patients.

Incidence of Brain Metastasis in Lung Adenocarcinoma at Initial Diagnosis on the Basis of Stage and Genetic Alterations

양범희,이현,엄상원,조재일,심영목,권오정,이경수,김호중 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-

Patients with lung adenocarcinoma (ADC) are at higher risk of the development of brain metastasis (BM), and genetic mutations such as EGFR and K-RAS are associated with BM. However, data on the incidence of BM according to stage and genetic mutations in lung ADC are limited. A total of 598 patients with lung ADC were retrospectively reviewed. We evaluated the incidence of BM by stage and genetic mutations. Of the 598 patients, 97 (16.2%) had BM, which occurred across all stages. BM incidence increased significantly as disease progressed (1.3% in stage I, 9.2% in stage II, 22.8% in stage III, 31.3% in stage IV; p<0.001). Multivariate analyses revealed that T4 diseases (adjusted odds ratio [OR]=2.29, 95% CI=1.04-5.07), diseases involving any lymph node (LN) involvement (adjusted ORs=5.35, 95% CI=1.96-14.20; 3.65, 1.65-8.27; and 6.19, 2.90-13.77 for N1, N2, and N3), and diseases with M1b/M1c (adjusted OR=4.52, 95% CI=2.53-8.20) were associated with BM. EGFR mutations were associated with BM in never- smokers (adjusted OR=2.07, 95% CI=1.02-4.34) and K-RAS mutations were risk factors for BM in males (adjusted OR=3.86, 95% CI=1.01-14.43). Although patients with EGFR mutations had BM across all stages, including stage I, those with K-RAS or ALK mutations had BM only in stage III and IV diseases. BM occurred in approximately 16% of lung ADC patients, including 3% with stage I diseases. Large tumor size, LN involvement, and distant metastases were closely associated with BM. While EGFR mutations were risk factors for BM among never-smokers, K-RAS mutations were risk factors among males.

F-95 A validation of four malignancy prediction models in pulmonary nodules

양범희,전병우,신선혜,이경종 대한결핵 및 호흡기학회 2016 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.121 No.-

There are four most commonly used clinical prediction models that estimate the probability of malignancy in pulmonary nodules. While three models are based on clinical and computed tomography (CT) characteristics (Mayo Clinic, Veterans Association, Brock University), one model additionally used positron emission tomography (PET) characteristics (Herder model). This study aimed to compare these four models at our institution. Retrospective analysis of 242 patients with pathologically confirmed nodules (4-30 mm in diameter) from January 2015 to December 2015 was performed. Receiver operating characteristic area under the curve (AUC) analysis was used to assess the predicting accuracy for malignancy. Of 242 patients, 187 patients (77.2%) had malignant nodules and 55 patients (22.8%) had benign nodules. PET was performed in 236 patients (97.5%). The Mayo, Brock and Veterans Association (VA) models showed similar performance (AUC 0.6337 vs. AUC 0.7138 vs. AUC 0.6121 respectively). Accuracy of the Herder model (AUC 0.6429) was not significantly different from those of the other three models (Mayo vs. Herder P=0.8262, Brock vs. Herder P=0.1435, VA vs. Herder P=0.5581). There were no differences among four models in determining probability of malignancy in pulmonary nodules. The usefulness of PET in predicting malignancy was limited in our study.

종격종 자세포종양 항암 치료 2개월 후 발생한 골수형성이상증후군

양범희 ( Bum Hee Yang ),신선혜 ( Sun Hye Shin ),김지혜 ( Ji Hye Kim ),김민선 ( Min Sun Kim ),박실비아 ( Silvia Park ),장준호 ( Jun Ho Jang ),정철원 ( Chul Won Jung ) 대한내과학회 2016 대한내과학회지 Vol.90 No.5

Here, we report on a 20-year-old patient with a primary nonseminomatous mediastinal germ cell tumor (MGCT) who developed myelodysplastic syndrome (MDS) 2 months following chemotherapy with cisplatin, etoposide, ifosfamide, and paclitaxel. Bone marrow examinations revealed that the MDS was a refractory anemia with excess type II blasts and complex chromosomal abnormalities. With the onset of MDS occurring rapidly following chemotherapy, it is unlikely to have been caused by the therapy. We discuss the association between primary nonseminomatous MGCTs and hematological malignancies, including the possibility of a common clonal origin. (Korean J Med 2016;90:460-463)

캔디다 종에 의해 발생한 기관기관지염의 임상양상

길현일,양범희,유홍석,정병호,서지영,김호중,이현 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.0

배경: 캔디다(Candida) 종은 객담이나 기관지세척액 등 호흡기 검체에서 종종 확인되는 균주이지만 병원균보다는 집락화균(colonization)인 경우가 대부분이다. 캔디다 종은 면역저하 환자에서 폐 감염을 일으킬 수 있다는 보고가 있지만, 기관기관지염(tracheobronchitis)을 일으키는지에 대해서는 알려져 있지 않다. 방법: 기관지 생검을 통해 조직학적으로 캔디다 감염이 확인된 캔디다 기관기관지염의 특징과 임상적 의미를 알아보기 위해, 1994년 12월부터 2018년 6월까지 기관지 생검에서 캔디다 감염이 확인된 증례를 후향적으로 분석하였다. 결과: 기관지 생검에서 캔디다 감염증으로 확인된 환자는 총 8명이었다. 기관지내시경 소견을 바탕으로 국소형(focal form, 5명)과 미만형 (diffuse form, 3명)으로 구분하였다. 미만형 환자는 3명 모두 절대 호중구 수가 100개 미만의 심한 백혈구감소증 상태였다. 국소형 환자 5명 중 2명은 정상 면역상태였으나 국소적인 폐절제술이나 기관지내 스텐트삽입술 등의 국소적 기관지 손상을 받은 적이 있었다. 그 외 3명의 국소형 환자들은 기저질환에 대해 항암치료 혹은 고용량 스테로이드 치료를 받던 중 캔디다 감염이 발병하였다. 미만형 환자 3명과 국소형환자 2명, 총 5명에게 항진균제치료를 시도하였다. 이 중 3명은 동반된 다른 세균감염증의 악화로 수일에서 수개월 내에 사망하였고 2명은 항진균제 치료 후 호전되었다. 치료를 하지 않은 3명의 국소형 환자는 캔디다 감염과는 직접 연관성이 없는 기저질환의 악화나 동반 감염증의 악화로 사망하였다. 결론: 캔디다 종은 면역저하 환자나 국소적 기관지 손상이 있는 환자에서 기회 감염을 일으킬 수 있다. 특히 심한 면역저하 환자에서 나타나는 미만성 캔디다 감염증은 예후가 나빴다.

A case of Alagille syndrome presenting with chronic cholestasis in an adult

김지혜,양범희,백남영,최연호,백용한 대한간학회 2017 Clinical and Molecular Hepatology(대한간학회지) Vol.23 No.3

Alagille syndrome (AGS) is a complex multisystem disorder that involves mainly the liver, heart, eyes, face, and skeleton. The main associated clinical features are chronic cholestasis due to a paucity of intrahepatic bile ducts, congenital heart disease primarily affecting pulmonary arteries, vertebral abnormalities, ocular embryotoxon, and peculiar facies. The manifestations generally become evident at a pediatric age. AGS is caused by defects in the Notch signaling pathway due to mutations in JAG1 or NOTCH2. It is inherited in an autosomal dominant pattern with a high degree of penetrance, but variable expressivity results in a wide range of clinical features. Here we report on a 31-year-old male patient who presented with elevated serum alkaline phosphatase and gamma-glutamyl transpeptidase, and was diagnosed with AGS associated with the JAG1 mutation after a comprehensive workup.

Factors associated with poor glycemic control in Korean patients with type 2 diabetes mellitus

박정현,양범희,전현정,이동화 대한내과학회 2022 대한내과학회 추계학술발표논문집 Vol.2022 No.2