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비소세포 폐암의 흉곽내 림프절 전이 판정에 있어서 림프절 크기 기준의 비교
국향,양세훈,정은택 圓光大學校 醫科學硏究所 2001 圓光醫科學 Vol.16 No.1-2
배경: 폐암의 흉곽내 림프절 전이 판정에 있어서 조직병리학적 방법이 아닌 CT에 의한 방법으로서는 정확성에 한계가 있다. 정상적으로 흉곽내의 림프절의 위치에 따라 정상 크기의 차이가 있으며, 폐암의 초기전이에는 림프절이 충분히 확대되지 않는다. 저자들은 지금까지의 림프절 장경 10㎜ 또는 15㎜ 이상을 전이기준으로 하는 일률적인 방법보다, 흉곽내 림프절의 위치에 따라 전이 기준을 달리하는 변형된 방법을 시도하여 비교하였다. 대상 및 방법: 폐암 절제술을 받은 57례를 대상으로 수술전 CT필름상 림프절의 장경을 재측정하고, 흉곽내 림프절 생검 소견과 비교하였으며, 저자들의 변형된 방법은 ATS map 4,5,7,10R은 장경 15㎜ 이상을 나머지는 장경 10㎜ 이상을 전이기준으로 하여, 장경 10㎜ 이상, 15㎜ 이상을 전이 기준으로 인정한 군과 예민도, 특이도, 양성 및 음성 예측도, 정확도를 비교하였다. 결과: 예민도, 특이도, 양성 예측도, 음성 예측도, 정확도가 10㎜이상 기준군에서는 97%, 54%, 68%, 94%, 75%였으며, 15㎜이상 기준군에서는 79%, 75%, 77%, 77%, 77%였으며, 변형된 기준군에서는 85%, 75%, 78%, 84%, 81%였다. 결론: 폐암의 흉곽내 림프절 전이 인정기준은 림프절의 장경을 일률적으로 10㎜ 또는 15㎜이상으로 하는 것보다, 흉곽내 림프절의 위치별로 전이 인정기준을 달리하는 방법이 더 정확하다고 사료된다. Background : The original purpose for the CT scan of the chest was that it would be able to predict involvement of the intrathoracic lymph node in the lung cancer noninvasively. When trying to evaluate nodal involvement by CT scan, largest diameter of nodes must be measured. Intrathoracic nodes larger than 15㎜ in diameter have cancer involvement in 94 - 97%, whereas nodes ranging from 10 to 15㎜ have cancer involvement in 50%, and those less than 10㎜ are usually uninvolved. Diameter of normal intrathoracic lymph node is influenced by location, as larger nodes in subcarinal area and smaller nodes in paraesophageal area. So, we tried to analyse the accuracies between nodal involvement criteria according to largest diameter by CT scan (positive if larger than 10㎜, 15㎜ and our modified criterion). Materials and Methods : We regarded them as involvement if ATS node No.4, 5, 7, 10R were larger than 15㎜ and others were larger than 10㎜ in diameter. The pathologic involvement and size of the nodes removed from surgery of 57 patients with proven lung cancer were analysed. Results : The sensitivity, specificity, positive and negative predictive value and accuracy were 97%, 54%, 68%, 94%, 75% in critierion as node involvement if larger than 10㎜. There were 79%, 75%, 77%, 77%, 77% in criterion as node involvement if larger than 15㎜, and those were 86%, 75%, 78%, 84%, 81% in our modified critierion. Conclusion: Our modified criterion for intrathoracic lymph node involvement (as positive if largest diameter of ATS map 4,5,7,10R were larger than 15mm, and those of others were larger than 10㎜) was more accurate than other previous criteria (as positive if largest diameter of lymph node were larger than 10㎜ or 15㎜).
박병현,고혁재,이명수,국향,구기선,김학렬,정은택 圓光大學校 醫科學硏究所 1998 圓光醫科學 Vol.14 No.2
Neurofibromatosis, which was described by von Recklinghausen in 1882, is a hereditary, hamartomatous disorder that primarily involves neuroectoderm and mesoderm. The clinical features are skin manifestations such as cafe-au-lait spots, skeletal manifestations primarily involving vertebrae, central and peripheral nervous manifestations, and other associated abnormalities with increased risk of malignancy. Malignant transformation in neurofibromatosis is estimated at 2-29 %, with malignant schwannoma being the most common malignancy. Malignant schwannoma associated with von Recklinghausen's disease has been rarely reported in Korea. We herein report a case of multiple malignant schwannoma associated with neurofibromatosis report this case with a review of literatures.