흉곽내 병변의 진단에 절단침과 세흡인침을 이용한 경피적 침생검술의 비교

이양근(Yang Keun Rhee),곽재용(Jae Yong Kwak),송정선(Jeong Sun Song),김재헌(Jae Hean Kim),유관희(Kwan Hee You),이용철(Yong Chul Lee),한영민(Young Min Han) 대한내과학회 1996 대한내과학회지 Vol.51 No.3

N/A Objectives: Percutaneous needle biopsy in the most reliable invasive method of obtaining the confirm diagnosis of peripheral pulmonary nodule. Needle aspiration combinde with cytologic examination is being used with increasing frequency in the diagnosis of pulmonary nodules and masses. Percutaneous needle lung biopsy was done in pulmonary or mediastinal lesions using 19 Gauge fine aspiration needle or 14 Gauge cutting needle, and the results were compared with respect to diagnostic accuracy and complications. Methods: Over a periods of recent ten years. 476 patients who had localized pulmonary lesions and underwent percutaneous needle lung aspiration and biopsy using 19 Gauge fine aspiration needle or 14 Gauge cutting needle. Results: The age distribution of the patients was from sixteen to eighty-one years old. Among 467 patients, 337 patients were male and 130 patients were female. In 244 patients, sizes of the lesions were less than 4cm, in largest diameter, and in 223 patients, sizes of the lesions were larger than 4cm, but the size of the lesion was not correlated with malignancy. Diagnosic yields of the 14 Gauge cutting needle and the 19 Gauge fine needle were 88.3% and 78.3% respectively. Success rate of benigm and malignant lesion was more higher in 14 Gauge cutting needle than 19 Gauge fine aspiration needle. Common diseases were priamry lung cancer, tuberculoma, abscess in order of frequency. The complications of procedure were mild pneumothorax in ten patients, mild hemoptysis in six patients and subcutaneous emphysema in one patient. With Cutting needle and aspiration needle, complication rate was 2.73% and 2.36%, respectively. Conclusion: Percutaenous needle lung biopsy with cutting needle under the chest computed tomogram and biplane fluoroscopy had lower complication rate and high diagnostic success rate for the intrathoracic lesions

경피적 세흡인침과 절단침을 이용한 흉곽내 병변의 진단적 가치에 대한 연구

이양근,곽재용,송정선,김재헌,유관희,이용철,박성광,백홍선,강성귀 의과학연구소 1996 全北醫大論文集 Vol.20 No.1

Percutaneous needle biopsy is most reliabel noninbasive method of obtaining the confirm diagnosis of peripheral pulmonary nodule. Needle aspiration combined with cytologic examination is being used with increasing frequency in the diagnosis of pulmonary nodules and masses. Percutaneous needle lung biopsy way done in pulmonary or mediastinal lesions using 19 Gauge fine aspiration needle or 14 Gauge cutting needle, and the results were compared with respect to diagnostic accuracy and complications. Over a periods of recent ten years,476 patients who had localized pulmonary lesions and underwent percutaneous needle lung aspiration and biopsy using 19 Gauge fine aspiration needle or 14 Gauge cutting needle. The age distribution of the patients was from sixteen to eighty-one years old. Among 467 patients, 337 patients were male and 130 patients were female. In 244 patients, the lesion were less than 4cm in largest diameter, and in 223 patients, the lesion were larger than 4cm, but the size of the lesion was not correlated with malignancy. Diagnosic yields of the 14 Gauge cutting needle and the 19 Gauge fine needle were 88.3% and 76.8% respectively. Success rate of benign and malignant lesion were more higher in 14 Gauge cutting needle than 19 Gauge fine aspiration needle. Common diseases were primary lung cancer, tuberculoma, abscess in order of frequency. The complications of procedure were mild pneumothorax in ten patients, mild hemoptysis in six patients and subcutaneous emphysema in one patients. With Cutting needle and aspiration needle, complication rate were 2.73% and 2.36%, respecitvely. Percutaneous needle lung biopsy with cutting needle under the chest computed tomogram and biplane fluroscopy had lower complication rate and high diagnostic success rate for the intrathoracic lesions.

요추병변에 시행한 천자생검법의 임상적 고찰

임영,신규호,김병직,서광윤,조혜제 인제대학교 1987 仁濟醫學 Vol.8 No.3

임상 증상, 검사 및 방사선 소견 통으로 확진이 어려운 척추병변에서 천자 생검법은 안전하고 편리하며 비교적 정확한 진단을 얻을 수 있고 특히 전이성 골암인 경우에는 불필요한 수술을 미연에 방지할 수 있으며 원발병소도 추적할 수 있는 장점이 있다. 본 교실에서는 7예의 요추병변에서 천자생검법을 시행하여 치료 방침을 결정하는데 큰 도움을 얻었기에 문헌 고찰과 함께 보고한다. The vertebral bodies are frequent sites of many different lesions and it is now generally agreed that it is difficult to make a definite diagnosis simply on the basis of the clinical features, laboratory test, roentgenograms, tomograms, and the like. Percutaneous needle biopsy is a safe, convenient and acurate method for diagnosing lesions of the spine, especially metastatic cancer, as it avoids the necessity for major surgery. Seven needle biopsies of vertebral bodies have been done without any complication in our hospital from Oct., 1986 to May, 1987. The results were as follows; 1.Among the seven cases of lumbar spinal lesion; four were metastatic lesions, one was osteoporotic compression fracture, one was chronic active osteomyelitis, and one was tuberculous spondylitis. 2.The technique of fine-needle aspiration biopsy seemed to be suited for the diagnosis of lytic bone lesions. 3.The technique of trephine biopsy seemed to be suited for the diagnosis of sclerotic lesions and the lesion that is covered with compact bone. 4.In the lumbar spine, trephine type needle is to be more useful for obtaining a core of bone for histopathology because the biopsy of lumbars spine is easier and safer than that of the thoracic or cervical spine. Computerized tomography could provide important information in planning a biopsy. Percutaneous needle bone biopsy seemed to be especially valuable in the spine, as it takes short operation time, and has rare complications and

경피적 바늘흡입생검 시술 후 피하로 파종된 간세포양 가슴샘암

윤정희 ( Jung Hee Yoon ),서수홍 ( Soo Hong Seo ),계영철 ( Young Chul Kye ),안효현 ( Hyo Hyun Ahn ) 대한피부과학회 2010 대한피부과학회지 Vol.48 No.12

Percutaneous needle aspiration biopsy is a reliable and useful procedure for diagnosing tumor with a low rate of complications and high diagnostic reliability. Subcutaneous malignant seeding of the needle tract is a well-known complication of percutaneous needle aspiration biopsy. Implantation metastases of the abdominal and chest walls have been reported after puncturing the tumor lesions of the liver, kidney, adrenal gland, lung and pleura. We report here on a case of subcutaneous seeding of hepatoid thymic carcinoma on the right upper back after a percutaneous needle aspiration biopsy. (Korean J Dermatol 2010;48(12):1104∼1107)

고립성폐결절의 경피적 바늘생검 이후 발생한 결핵성 흉수

구호석 ( Ho Seok Koo ),김태균 ( Tae Kyun Kim ),박성길 ( Sung Kil Park ),최상분 ( Sang Bun Choi ),김애란 ( Ae Ran Kim ),최상봉 ( Sang Bong Choi ),정훈 ( Hoon Jung ),박이내 ( I Nae Park ),허진원 ( Jin Won Hur ),이혁표 ( Hyuk Pyo Le 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.63 No.3

A tuberculous pleural effusion may be a sequel to a primary infection or represent the reactivation of pulmonary tuberculosis. It is believed to result from a rupture of a subpleural caseous focus in the lung into the pleural space. It appears that delayed hypersensitivity plays a large role in the pathogenesis of a tuberculous pleural effusion. We encountered a 52 years old man with pleural effusion that developed several days after a CT guided percutaneous needle biopsy of a solitary pulmonary nodule. He was diagnosed with TB pleurisy. It is believed that his pleural effusion probably developed due to exposure of the parenchymal tuberculous focus into the pleural space during the percutaneous needle biopsy. This case might suggest one of the possible pathogeneses of tuberculous pleural effusion. (Tuberc Respir Dis 2007; 63: 268-272)

영아 담도폐쇄증 진단에서 Tc-99m DISIDA 간담도주사와 경피간침생검의 의의

김우석,박우현,최순옥,김상표,Kim, Woo-Suk,Park, Woo-Hyun,Choi, Soon-Ok,Kim, Sang-Pyo 대한소아외과학회 1997 소아외과 Vol.3 No.1

본 저자들은 1992년 3월부터 1996년 4월까지 신생아 울체성 황달의 감별진단, 특히 신생아담도폐쇄증과 신생아 간염의 감별진단에 있어 Tc-99m DISIDA 간담도주사와 경피간침생검을 시행하여 다음과 같은 결과를 얻었다. 질환별로 볼 때 전체 60예의 환아 중에서 담도패쇄증이 23예, 신생아 감염이 34예였으며 경정맥고영양법으로 인한 황달이 2예, Alagille 증후군이 1예였다. Tc-99m DISIDA 간담도주사는 60명의 환아를 대상으로 실시하였다. BA 진단에 대한 민감도와 특이도는 각각 96%와 32%로서 높은 민감도를 보인 반면 특이도는 낮게 나타났으며 전체적인 진단 정확도는 57%였다. 경피간침생검은 Tc-99m DISIDA 간담도주사를 실시한 60명의 환아중 장관내 방사능이 나타나지 않았던 38명의 환아에서 40회 실시하였는데, 경피간침생검에 BA 진단에 대한 민감도는 88%, 특이도는 96%로 모두 높았으며 전체적인 진단 정확도는 93%였다. 본 연구를 요약하면 Tc-99m DISIDA 간담도주사는 특이도 32%, 양성예측율 47%로서 Tc-99m DlSIDA 간담도주사에서 장관내 방사능이 배설이 되지 않을 때는 경피간침생검이 반드시 필요하리라 생각되며, 일단 장관내 방사능이 배출되면 BA는 배제할 수 있으리라 생각된다. 경피간침생검은 전체적인 진단율이 93%로 높으나, BA 환아에서 8주전에 경피간침생검시는 NH와 감별이 어려울 수 있으며, 또 일부 NH, 경정맥고영양법 관련 울체성 황달에서는 경피간침생검시 BA와 감별이 어려울 수 있으므로, 임상경과를 보아서 의심스러우면 재 경피간침생검을 시행하던지 타 진단법을 응용해서 참고하여야 할 것으로 생각된다. To differentiate biliary atresia from intraheaptic cholestasis, Tc-99m DlSIDA hepatobiliary scintigraphies and percutaneous needle biopsies of 60 consecutive infants were evaluated retrospectively. Twenty three patients had biliary atresia and 37 patients intraheaptic cholestasis(neonatal hepatitis 34, TPN induced jaundice 2 and Dubin-Johnson syndrome 1). All sixty patients underwent Tc-99m DlSIDA hepatobiliary scintigraphy with phenobarbital pretreatment. Of 23 patients with biliary atresia, 22 were correctly interpreted showing 96% sensitivity while of 37 patients with intraheaptic cholestasis, only 12 had intestinal excretion of radionuclide showing 32% specificity. Among the forty needle biopsies, 17 of biliary atresia and 23 of intrahepatic cholestasis, 37 were correctly interpreted as either having biliary atresia or intrahepatic cholestasis. The overall diagnostic accuracy was 93%. Of 3 misdiagnosed cases, the histologic findings of two patients with biliary atresia(aged 43 days and 54 days at the first needle biopsy) were essentially the same as those of neonatal hepatitis. Follow-up biopsies, however, showed findings consistent with biliary atresia. The third one(VLBW premie with history of 8 weeks of TPN) showed mild ductal proliferation and portal fibrosis. This was interpreted as suspicious for biliary atresia. Jaundice resolved gradually. In summary, patients who have intestinal excretion of radionuclide on Tc-99m DlSIDA hepatobiliary scintigraphy, biliary atresia can be ruled out. But the patients who do not have intestinal excretion of radionuclide should have further investigation by needle biopsy. Judicious use of Tc-99m DISIDA hepatobiliary scintigraphy and percutaneous needle biopsy can give a diagnostic accuracy of 95% or more in cases of infantile cholestasis.

Learning Curve of C-Arm Cone-beam Computed Tomography Virtual Navigation-Guided Percutaneous Transthoracic Needle Biopsy

Su Yeon Ahn,박창민,윤순호,Hyungjin Kim,Jin Mo Goo 대한영상의학회 2019 Korean Journal of Radiology Vol.20 No.5

Objective: To evaluate the learning curve for C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous transthoracic needle biopsy (PTNB) and to determine the amount of experience needed to develop appropriate skills for this procedure using cumulative summation (CUSUM). Materials and Methods: We retrospectively reviewed 2042 CBCT virtual navigation-guided PTNBs performed by 7 novice operators between March 2011 and December 2014. Learning curves for CBCT virtual navigation-guided PTNB with respect to its diagnostic performance and the occurrence of biopsy-related pneumothorax were analyzed using standard and risk-adjusted CUSUM (RA-CUSUM). Acceptable failure rates were determined as 0.06 for diagnostic failure and 0.25 for PTNB-related pneumothorax. Results: Standard CUSUM indicated that 6 of the 7 operators achieved an acceptable diagnostic failure rate after a median of 105 PTNB procedures (95% confidence interval [CI], 14–240), and 6 of the operators achieved acceptable pneumothorax occurrence rate after a median of 79 PTNB procedures (95% CI, 27–155). RA-CUSUM showed that 93 (95% CI, 39–142) and 80 (95% CI, 38–127) PTNB procedures were required to achieve acceptable diagnostic performance and pneumothorax occurrence, respectively. Conclusion: The novice operators’ skills in performing CBCT virtual navigation-guided PTNBs improved with increasing experience over a wide range of learning periods.

Cutaneous Metastasis of Pancreatic Carcinoma by Percutaneous Fine Needle Aspiration Biopsy

Kim, Jin-Hwan,Lee, Mu-Hyoung,Haw, Choong-Rim Korean Dermatological Association 1995 Annals of Dermatology Vol.7 No.2

CT 유도하 국소적 폐질환의 경피적 흡입생검의 장점과 결과 분석

박복환,변우목,조길호,황미수,장유송 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.1

PTNB는 최근 CT 기술의 발전과 20 gauge 또는 22 gauge 의 세침의 개발로 합병증을 줄이는 한편, 성공율이 높아 점차 임상적으로 널리 이용되는 추세에 있다. 이에 저자는 최근 44례의 PTNB를 분석하여 다음과 같은 결과를 얻었다. 환자의 분포는 50대 남자가 17례로 가장 많았고 종괴의 크기와 위치는 4㎝ 전후가 36례(84%)로 가장 많았다. 종괴의 국소적 위치는 변연부에 위치한 것이 33례(75%)의 주로 폐의 변연부에 위치하였다. 조직 채취는 42례 (95%)에서 가능 했으며, PTNB의 민감도는 61% (27/44)였고 악성종괴와 양성종괴에 대한 민감도는 각각 79% (19/24), 44% (8/18)였다. 민감도가 비교적 낮은 이유는 단 1회 시술로 결과를 얻었고 민감도를 높이기 위한 반복 PTNB는 시행하지 않았기 때문으로 생각한다. 합병증인 기흉이나 각혈은 각각 1례에서 얻었고 모든 특별한 치료없이 호전되었다. 이상에서 PTNB는 다른 검사 방법보다 간편하고 안전하며 기관지경을 통한 생검이 불가능하거나 생검후에도 병리소견을 못얻을 경우 PTNB를 통해 양성질환과 악성질환을 구분하므로써 환자의 치료 방침 결정에 도움을 줄수 있을것으로 사료되며, 국소적 폐 질환의 진단에 있어서 PTNB의 유용성은 더욱 증가하리라고 전망된다. Percutaneous needle biopsy of pulmonary lesion with use of fluoroscopic guidance is well established as a diagnostic tool but limited by the small size and inaccessibility of certain lesions. However, percutaneous needle biopsy has been used increasingly in relation to advance and the safety of smaller biopsy needle and new imaging modalities such as ultrasound and CT. CT, because of its characteristics of high resolution, allows tissue sampling with considerable safety from area that heretofore could not be visualized under fluoroscopy. The authors summarized 44 pulmonary lesions hat underwent CT-guided transthoracic biopsy with fine-needle over a 14 month period and analyzed the sensitivity of PTNB. CT-guided PTNB was done with 20 gauge or 22 gauge Westcott biopsy needle (Manan medical products, USA). A diagnosis was made in 27 of 44 cases (61%) including malignancy in 19 of 24 cases and benignancy in 8 of 20 cases. The pulmonary mass lesions were located at the peripheral zone of the lung field in 33 cases and at the central zone in 11 cases. Complications were observed in 2 cases which were pneumothorax and hemoptysis each but specific therapy was not required. The sensitivity of PTNB by one session was 61% (27/44). The sensitivity of malignancy was 79% (19/24) and benignancy was 40% (8/20). These results suggest the usefulness of PTNB using fine needles be increased in earlier diagnosis and improved staging of pulmonary nodular lesions without significant complications.

경피적 골생검용 아크릴 바늘의 제작과 유용성

김태형(Tae-Hyung Kim),신명진(Myung Jin Shin),신지훈(Ji Hoon Shin),임진오(Jin-Oh Lim),류지연(Ji-Yeon Ryu),오제선(Jae-Seon Oh),우철웅(Chul-Woong Woo),남증희(Jeung Hee Nam) 대한방사선과학회(구 대한방사선기술학회) 2010 방사선기술과학 Vol.33 No.1

호박을 대상으로 새로 개발된 골생검용 바늘의 유용성을 평가하고자 본 실험을 하였으며, 골생검용 바늘은10 mm 직경의 아크릴 재료를 사용하여 내부가공을 달리 하여 3가지 형태로 제작하였다. 임상에서 사용되는구조와 유사한 구조로 재현하여(Conventional type, Ct) 실험군과 비교하였다. Type a(Ta)는 바늘의 원위부 1cm 부분에 내부가공을 하였고, Type b(Tb)는 원위부로부터 동일 길이까지 점점 가늘게 제작하였고, Type c(Tc)는 내부에 동일 길이로 나사산을 제작하였다. 호박 표면으로부터 10 mm되는 부분까지의 생검 채취를 목적으로 20회를 시행하였으며, 시술 성공률, 채취된 표본의 길이 등을 측정하여 가장 적절한 생검용 바늘의 구조를 평가하고자 하였다. 그 결과 생검술의 성공률은 각각 Ct는 55%, Ta는 80%, Tb는 90%, Tc는 100%이었으며, 생검된 표본의 양은 Ct는 5.6±1.1 mm, Ta는 5.9±0.87 mm, Tb는 3.9± 0.77 mm, Tc는 9.4±0.54 mm이었다. 그룹별 통계적 유의성은 Ct와 Ta(p = 0.28)를 제외한 모든 그룹에서 통계적 의미를 가졌다(p < 0.05). 따라서 새로 개발된 골생검용 바늘은 생검술에 유용하게 사용될 것으로 사료되며, 그중 내부의 나선 가공이 된 Tc형의 바늘이 골 생검에 가장 적절한 구조라 예상된다. To evaluate the usefulness of newly designed percutaneous bone biopsy needle for pumpkin's specimen collection. We manufactured three types of biopsy needle with different internal processing which were made of 10 mm-diameter acrylic material. We made the conventional type (Ct) similar to the clinical type then compared the test group. The type a (Ta) made 1 cm-length internal processing from the distal, type b (Tb) made taper, and type c (Tc) made internal processing like spiral configuration. We performed 20 times biopsy to get an 10 mm length specimen from pumpkin's surface and evaluated the success rate of the biopsy, length of the specimen, and determine internal processing type of the most suitable biopsy needle (ANOVA test). Success rates of Ct, Ta, Tb, and Tc were 55%, 80%, 90%, and 100%, respectively. The lengths of the specimen of Ct, Ta, Tb, and Tc were 5.6±1.1 mm, 5.9±0.87 mm, 3.9±0.77 mm, and 9.4±0.54 mm, respectively. All groups were statistically significant (p < 0.05) except the group between Ct and Ta (p = 0.28). Newly designed bone biopsy needle seems to be useful for obtaining enough specimen. Tc may be more effective than other types.