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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-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.
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.
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.
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.
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.
증례 : 혈액종양 ; 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)
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.