Ju Ock Na

Background/Objectives: We aimed to compare the diagnostic performances of planar bone scintigraphy and whole-body 360° cadmium–zinc–telluride (CZT) bone single-photon emission computed tomography/computed tomography (SPECT/CT) in detecting bone metastasis in patients with small cell lung cancer (SCLC). Methods: We retrospectively evaluated two separate, non-randomized cohorts of 175 patients with SCLC who underwent staging bone scintigraphy, comprising 93 and 82 patients who underwent planar bone scintigraphy using a conventional dual-head gamma camera and whole-body bone SPECT/CT using a full-ring 360° CZT camera, respectively. Both imaging examinations were visually assessed and compared using patient- and lesion-based analyses of their diagnostic performances. Results: Whole-body bone SPECT/CT showed fewer equivocal findings and almost perfect inter-reader agreement. On the patient-based analysis, whole-body bone SPECT/CT demonstrated higher unadjusted observed diagnostic accuracy than planar bone scintigraphy (87.8% vs. 73.1%; p = 0.016), with higher observed sensitivity (79.2% vs. 53.3%), specificity (91.4% vs. 82.5%), positive predictive value (79.2% vs. 59.3%) and negative predictive value (91.4% vs. 78.8%). However, on a lesion-based analysis, whole-body bone SPECT/CT exhibited a low sensitivity of 47.5%, with particularly low detection rates for spine and pelvic metastases (29.4%), despite showing higher observed sensitivity than planar bone scintigraphy (20.1%). Conclusions: In two separate retrospective cohorts of SCLC patients, whole-body bone SPECT/CT showed higher unadjusted observed patients-based diagnostic performance than planar bone scintigraphy. However, its lesion-level sensitivity remained low, particularly in the spine and pelvis.

Background: Bronchodilator response (BDR) is occasionally observed in patients with bronchiectasis. However, clinical implications of BDR of bronchiectasis remain unclear. This multicenter observational cohort study aimed to compare clinical characteristics and severity in bronchiectasis between patients with BDR and without BDR. Methods: We collected data from the Korean Multicenter Bronchiectasis Audit and Research Collaboration (KMBARC) registry, a multicenter observational cohort of non-cystic fibrosis bronchiectasis. We reviewed the medical records of 709 patients who underwent spirometry. We defined BDR as forced expiratory volume in one second (FEV₁) or forced vital capacity (FVC) improvement from pre-bronchodilator value by at least 200 mL and 12% for baseline or 1-year follow-up spirometry. Results: Of the 709 patients, 7.3% exhibited BDR. Patients with BDR showed worse pulmonary function than those without BDR, both at baseline (FEV₁%, 52.7% vs. 65.3%) and at 1-year follow-up spirometry (52.2% vs. 62.9%). Inhaled corticosteroid (ICS)-containing agents were more frequently used in patients with BDR than those without BDR. Patients with BDR showed higher rates of emergency room visits (15.4% vs. 6.7%) and hospitalization (30.8% vs. 16.6%) than those without BDR. When measuring bronchiectasis severity with Bronchiectasis Severity Index, FACED [F: FEV₁; A: age; C: chronic colonization by Pseudomonas aeruginosa, E: radiological extension (number of pulmonary lobes affected), and D: dyspnea], and E-FACED (FACED plus exacerbations) scores, patients with BDR showed more severe bronchiectasis status than those without BDR. Conclusions: In bronchiectasis, BDR is associated with poorer lung function, more frequent exacerbation, and increased disease severity.

Asthma is a chronic inflammatory disease of the airways characterized by varying and recurrent symptoms, reversible airway obstruction, and bronchospasm. In this paper, clinical important studies on asthma published between March 2021 and February 2022 were reviewed. A study on the relationship between asthma and chronic rhinosinusitis, bronchiectasis, and hormone replacement therapy was published. A journal on the usefulness of fractional exhaled nitric oxide for the prediction of severe acute exacerbation was also introduced. Studies on the effect of inhaler, one of the most important treatments for asthma, were published. Studies on the control of severe asthma continued. Phase 2 and 3 studies of new biologics were also published. As the coronavirus disease 2019 (COVID-19) pandemic has been prolonged, many studies have explored the prevalence and mortality of COVID-19 infection in asthma patients.

The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a validated, eight-item questionnaire used to quantify the health status of patients. The aim of this study was to evaluate the usefulness of the CAT questionnaire as a tool to assess the response to treatment in acute exacerbations of COPD in an outpatient setting. A multicenter, phase 3 randomized controlled trial was conducted previously to examine the efficacy and safety of oral zabofloxacin for the treatment of COPD exacerbations. In the present post hoc analysis of the original study, patients with COPD exacerbation were categorized as responders or non-responders according to the respiratory symptoms persisting on day 10 (visit 3) of treatment. The CAT questionnaire was completed daily by patients at home from the initial visit to the second visit on day 5. Subsequently, the questionnaire was completed in the presence of a physician on days 10 (visit 3) and 36 (visit 4). Multivariate regression analysis was performed to determine the association between CAT scores and the therapeutic response. The CAT scores decreased more rapidly in responders compared to non-responders during the first 5 days (23.3-20.4 vs. 23.5-22). Among responders, patients with higher severity of illness also revealed higher CAT scores on the first day of an exacerbation (mild, 19.8; moderate, 21.4; severe, 23.8; very severe, 28.6). Multivariate analysis revealed that a change in the CAT score during the first 3 days influenced the therapeutic response. A significant decrease in scores in the domains of sputum production, chest tightness, and activities of daily living was seen among responders. Early improvement in CAT scores may be associated with a more favorable response to the treatment of COPD exacerbations. ClinicalTrials.gov Identifier: NCT01658020. Clinical Research Information Service Identifier: KCT0000532.

To use serological and multiplex polymerase chain reaction (PCR) assays to examine sputum samples from patients experiencing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) for the presence of atypical pathogens, including Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila. From September 2012 to February 2014, 341 patients with AECOPD attending outpatient clinics were enrolled as part of a randomized, double-blind, multicenter study. A commercial enzyme-linked immunosorbent assay was used to measure serum immunoglobulin M (IgM) and IgG antibody titers on the first day of the study and at 36 days post-enrollment. Multiplex PCR was used to test sputum samples for the presence of atypical pathogens. A urinary antigen test for L. pneumophila was performed on the first day. Nineteen patients (5.6%) showed serological evidence of acute infection with M. pneumoniae. Also, one and seven patients (2%) showed serological evidence of acute infection with C. pneumoniae and L. pneumophila, respectively. All DNA samples were negative for M. pneumoniae, C. pneumoniae, and L. pneumophila according to PCR. Only one urine sample was positive for L. pneumophila antigen, but serologic evidence was lacking. Serological testing suggested that infection by atypical pathogens during AECOPD was relatively uncommon. In addition, PCR provided no direct evidence of infection by atypical pathogens. Thus, atypical pathogens may not be a major cause of AECOPD in South Korea.

Pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma is a rare disease and usually presents as pulmonary masses, mass-like consolidation, or pulmonary nodules on chest images. We report a case of a 43-year-old man with symptoms of chronic cough for 1 year, showing bilateral diffuse bronchovascular bundle thickening and focal ground glass opacities on a chest computed tomography scan. Video-assisted thoracoscopic surgery was performed and the final pathologic diagnosis was pulmonary MALT lymphoma. Concurrent involvement of the pancreas was discovered during staging workup. After diagnosis, he was treated with cytotoxic chemotherapy and rituximab and showed improvements in his lung lesion and pancreas.

Metastatic squamous cell carcinoma from a cancer of unknown primary (CUP) affecting the intrathoracic lymph node is very rare. We reported a case of metastatic squamous cell carcinoma in the hilar and interlobar lymph node from a patient with CUP and reviewed the associated literature. Abnormal mass in the right hilar area was incidentally detected. A chest computed tomography scan showed a 2.5-cm diameter mass in the right hilum that had changed little in size for 3 years. The patient underwent a right pneumonectomy and mediastinal lymph node dissection. A metastatic squamous cell carcinoma in the hilar and interlobar lymph nodes without a primary lung or other lesion was diagnosed. The patient received adjuvant chemotherapy for a diagnosis of T0N1M0 lung cancer.