대한세포병리학회지 (The Korean Journal of Cytopathology)

대한세포병리학회 (The Korean Society for Cytopathology)
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폐암 진단방법으로서 객담검사의 유용성

Usefulness of Sputum Cytology as a Diagnostic Tool of Lung Cancer

  • 조은윤 (성균관대학교 강북삼성병원 병리과) ;
  • 박희대 (성균관대학교 강북삼성병원 병리과) ;
  • 김선희 (성균관대학교 강북삼성병원 병리과) ;
  • 박운선 (성균관대학교 강북삼성병원 병리과) ;
  • 채승완 (성균관대학교 강북삼성병원 병리과) ;
  • 김어진 (성균관대학교 강북삼성병원 병리과) ;
  • 손진희 (성균관대학교 강북삼성병원 병리과)
  • Cho, Eun-Yoon (Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Hee-Dae (Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Sun-Hee (Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Park, Woon-Sun (Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Chae, Seoung-Wan (Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Kim, Eo-Jin (Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine) ;
  • Sohn, Jin-Hee (Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 발행 : 2004.11.30
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초록

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.

키워드

참고문헌

  1. 2001 한국 중앙 암등록 사업 연례 보고서. 보건복지부
  2. Patz EF Jr, Goodman PC, Bepler G. Screening for lung cancer. N Engl J Med 2000;343:1627-33 https://doi.org/10.1056/NEJM200011303432208
  3. Frost JK, Ball WC Jr, Levin ML，et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis 1984;130:549-54
  4. Flehinger BJ, Melamed MR, Zaman MB, Heelan RT, Perchick WB, Martini N. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study. Am Rev Respir Dis 1984;130:555-60
  5. Fontana RS, Sanderson DR, Taylor WF, et al. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis 1984;130:561-5
  6. Petty TL. Screening strategies for early detection of lung cancer: the time is now. JAMA 2000;284:1977-80 https://doi.org/10.1001/jama.284.15.1977
  7. Kern WH. The diagnostic accuracy of sputum and urine cytology. Acta Cytol 1988;32:651-4
  8. Ng AB, Horak GC. Factors significant in the diagnostic accuracy of lung cytology in bronchial washing and sputum samples. II. Sputum samples. Acta Cytol 1983;27:397-402
  9. Tanaka T, Yamamoto M, Tamura T, et al. Cytologic and histologic correlation in primary lung cancer. A study of 154 cases with resectable tumors. Acta Cytol 1985;29:49-56
  10. Gupta RK. Value of sputum cytology in the diagnosis and typing of bronchogenic carcinomas, excluding adenocarcinomas. Acta Cytol 1982;26:645-8
  11. Pilotti S, Rilke F, Gribaudi G, Ravasi GL. Sputum cytology for the diagnosis of carcinoma of the lung. Acta Cytol 1982;26:649-54
  12. Oswald NC, Hinson KF, Canti G, Miller AB. The diagnosis of primary lung cancer with special reference to sputum cytology. Thorax 1971;26:623-7 https://doi.org/10.1136/thx.26.6.623
  13. 김준미. 민수기. 주영채. 조철호. 기관지암종 진단에 있어서 객담과 기관지 세척액 검사의 유용성. 대한세포병리학회지 2001;12:17-23
  14. 이혜경. 이광민. 정동규. 강대송. 김기완. 폐암진단을 위한 객담세포검사 결과-16개월간의 전주예수병원 객담세포검사 결과를 바탕으로. 대한세포병리학회지 1994;5:148-53
  15. 박인애. 함의근. 폐암의 세포병리학적 진단에 관한 검토. 대한세포병리학회지 1991;2:20-7
  16. Risse EK, Vooijs GP, van’t Hof MA. Relationship between the cellular composition of sputum and the cytologic diagnosis of lung cancer. Acta Cytol 1987;31:170-6
  17. Wandall HH. A study on neoplastic cells in sputum as a contribution to the diagnosis of pulmonary lung cancer. Acta Chir Scand 1944;91:485-9
  18. Spjut HJ, Fier DJ, Ackerman LV. Exfoliative cytology and pulmonary cancer. J Thorac Surg 1955;30:90-99
  19. Koss LG. Progress in cytologic diagnosis of lung cancer. Proc Natl Cancer Conf 1970;6:817-9
  20. Truong LD, Underwood RD, Greenberg SD, McLarty JW. Diagnosis and typing of lung carcinomas by cytopathologic methods. A review of 108 cases. Acta Cytol 1985;29:379-84
  21. Wang L, Wang G, Xia X. Detection of oncogenic mutations in sputum and its diagnostic value of lung cancer. Zhonghua Jie He He Hu Xi Za Zhi 1998;1:236-9
  22. Kersting M, Friedl C, Kraus A, Behn M, Pankow W, Schuermann M. 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. J Clin Oncol 2000;8:3221-9
  23. Bunn PA Jr. Molecular biology and early diagnosis in lung cancer. Lung Cancer 2002;38:S5-8 https://doi.org/10.1016/S0169-5002(02)00244-1
  24. Dai Y, Morishita Y, Mase K, et al. Application of the p53 and K-ras gene mutation patterns for cytologic diagnosis of recurrent lung carcinomas. Cancer 2000;90:258-63 https://doi.org/10.1002/1097-0142(20000825)90:4<258::AID-CNCR10>3.0.CO;2-F
  25. Shiono S, Omoe K, Endo A. K-ras gene mutation in sputum samples containing atypical cells and adenocarcinoma cells in the lung. Carcinogenesis 1996;17:1683-6 https://doi.org/10.1093/carcin/17.8.1683
  26. Tsou JA, Hagen JA, Carpenter CL, Laird-Offringa IA. DNA methylation analysis: a powerful new tool for lung cancer diagnosis. Oncogene 2002;21:5450-61 https://doi.org/10.1038/sj.onc.1205605
  27. Chen JT, ChenYC，Wang YC, Tseng RC, Chen CY, Wang YC. Alterations of the p16(ink4a) gene in resected nonsmall cell lung tumors and exfoliated cells within sputum. Int J Cancer 2002;98:724-31 https://doi.org/10.1002/ijc.10262
  28. Zhou J, Nong L, Wloch M, Cantor A, Mulshine JL, Tockman MS. Expression of early lung cancer detection marker: hnRNP-A2/B1 and its relation to microsatellite alteration in non-small cell lung cancer. Lung Cancer 2001;34:341-50 https://doi.org/10.1016/S0169-5002(01)00254-9