폐암 진단방법으로서 객담검사의 유용성 = Usefulness of Sputum Cytology as a Diagnostic Tool of Lung Cancer

다국어 초록 (Multilingual Abstract)

To analyze the accuracy and usefulness of sputum cytology as a screening method, 103 cases of histologically proven lung cancer registered from 1998 to 2000 at Kangbuk Samsung Hospital were retrospectively examined. We reviewed the original cytologic and surgical diagnoses for the cases, and the cytology slides of all cytologically negative cases. The overall sensitivity of sputum cytology was 0.83 ; the sensitivity of prebronchoscopy sputum cytology for bronchogenic carcinoma was 0.87. Central tumor location (P=0.002), tumor size (>2.4 cm), (P=0.027) and the number of sputum samples $(\geq3)$ (P=0.001) were associated with a positive cytologic diagnosis. Of the 18 cytologically negative cases, 9 cases(38% of smears) were determined to be insufficient for diagnosis, due strictly to low cellularity and saliva. After a review of the cytology slides of cytologically negative cases, we identified several atypical clusters in one case of bronchioloalveolar carcinoma. This negativity was thus attributed to an interpretation error (1/18, 5.6%). Our results suggest that its sensitivity is more strongly related to the specimen adequacy and the times of sampling than to interpretation error. In terms of sensitivity, specificity, accessibility, cost, and morbidity associated with the screening tests, sputum cytology was found to be an accurate effective screening method for lung cancer.

참고문헌 (Reference)

1 "함의근. 폐암의 세포병리학적 진단에 관한 검토. 대한세포병리학회지 1991" 20-7,

2 "김기완. 폐암진단을 위한 객담세포검사 결과-16개월간의 전주예수병원 객담세포검사 결과를 바탕으로. 대한세포병리학회지 1994" 148-53,

3 "기관지암종 진단에 있어서 객담과 기관지 세척액 검사의 유용성." 12 : 17-23, 2001

4 "van't Hof MA. Relationship between the cellular composition of sputum and the cytologic diagnosis of lung cancer. Acta Cytol 1987" 170-6,

5 "results of the initial radiologic and cytologic screening in the Memorial Sloan-Kettering study. Am Rev Respir Dis 1984" 555-60,

6 "results of the initial radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis 1984" 561-5,

7 "results of the initial radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis 1984" 549-54,

8 "et al. Cytologic and histologic correlation in primary lung cancer. A study of 154 cases with resectable tumors. Acta Cytol 1985" 49-56,

9 "Wandall HH. A study on neoplastic cells in sputum as a contribution to the diagnosis of pulmonary lung cancer. Acta Chir Scand 1944" 485-9,

10 "Screening strategies for early detection of lung cancer: the time is now." 284 : 1977-1980, 2000

11 "Screening for lung cancer." 343 : 1627-1633, 2000

12 "Ravasi GL. Sputum cytology for the diagnosis of carcinoma of the lung. Acta Cytol 1982" 649-54,

13 "Molecular biology and early diagnosis in lung cancer." 38 : 5-8, 2002

14 "Miller AB. The diagnosis of primary lung cancer with special reference to sputum cytology. Thorax 1971" 623-7,

15 "McLarty JW. Diagnosis and typing of lung carcinomas by cytopathologic methods. A review of 108 cases. Acta Cytol 1985" 379-84,

16 "Koss LG. Progress in cytologic diagnosis of lung cancer. Proc Natl Cancer Conf 1970" 817-9,

17 "Kern WH. The diagnostic accuracy of sputum and urine cytology. Acta Cytol 1988" 651-4,

18 "K-ras gene mutation in sputum samples containing atypical cells and adenocarcinoma cells in the lung." 17 (17): 1683-1686, 1996;

19 "Horak GC. Factors significant in the diagnostic accuracy of lung cytology in bronchial washing and sputum samples. II. Sputum samples. Acta Cytol 1983" 397-402,

20 "Gupta RK. Value of sputum cytology in the diagnosis and typing of bronchogenic carcinomas" 645-8, excludingadenocarcinomas.actacytol1982

21 Zhou J,, "Expression of early lung cancer detection marker: hnRNP-A2/B1 and its relation to microsatellite alteration in non-small cell lung cancer." 34 : 341-350, 2001

22 "Differential frequencies of p16(INK4a) promoter hypermethylation, p53 mutation, and K-ras mutation in exfoliative material mark the development of lung cancer in symptomatic chronic smokers." 8 : 3221-3229, 2000

23 "Detection of oncogenic mutations in sputum and its diagnostic value of lung cancer." 1 : 236-239, 1998

24 Tsou JA,, "DNA methylation analysis: a powerful new tool for lung cancer diagnosis." 21 : 5450-5461, 2002

25 "Application of the p53 and K-ras gene mutation patterns for cytologic diagnosis of recurrent lung carcinomas." 90 : 258-263, 2000

26 Chen JT,, "Alterations of the p16(ink4a) gene in resected nonsmall cell lung tumors and exfoliated cells within sputum." 98 : 724-731, 2002;

27 "2001 한국 중앙 암등록 사업 연례 보고서." 보건복지부 2001