Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Primary Synchronous Lung Cancer Detected using Autofluorescence Bronchoscopy

자가 형광 기관지 내시경을 이용한 동시성 원발성 폐암의 진단

  • Kwon, Sun Jung (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Lee, Yun Seun (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Joung, Mi Kyong (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Lee, Yu Jin (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Jang, Pil Soon (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Lee, Jeung Eyun (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Chung, Chae Uk (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Park, Hee Sun (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Jung, Sung Soo (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Kim, Sun Young (Department of Internal Medicine, College of Medicine, Chungnam National University) ;
  • Kim, Ju Ock (Department of Internal Medicine, College of Medicine, Chungnam National University)
  • 권선중 (충남대학교 의과대학 내과학교실) ;
  • 이연선 (충남대학교 의과대학 내과학교실) ;
  • 정미경 (충남대학교 의과대학 내과학교실) ;
  • 이유진 (충남대학교 의과대학 내과학교실) ;
  • 장필순 (충남대학교 의과대학 내과학교실) ;
  • 이정은 (충남대학교 의과대학 내과학교실) ;
  • 정재욱 (충남대학교 의과대학 내과학교실) ;
  • 박희선 (충남대학교 의과대학 내과학교실) ;
  • 정성수 (충남대학교 의과대학 내과학교실) ;
  • 김선영 (충남대학교 의과대학 내과학교실) ;
  • 김주옥 (충남대학교 의과대학 내과학교실)
  • Received : 2006.02.14
  • Accepted : 2006.05.29
  • Published : 2006.06.30
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Abstract

Objective: Patients with lung cancer have a relative high risk of developing secondary primary lung cancers. This study examined the additional value of autofluorescence bronchoscopy (AFB) for diagnosing synchronous lung cancers and premalignant lesions. Methods: Patients diagnosed with lung cancer from January 2005 to December 2005 were enrolled in this study. The patients underwent a lung cancer evaluation, which included white light bronchoscopy (WLB), followed by AFB. In addition to the primary lesions, any abnormal or suspicious lesions detected during WLB and AFB were biopsied. Results: Seventy-six patients had non-small cell lung cancer (NSCLC) and 23 had small cell lung cancer (SCLC). In addition to the primary lesions, 84 endobronchial biopsies were performed in 46 patients. Five definite synchronous cancerous lesions were detected in three patients with initial unresectable NSCLC and in one with SCLC. The secondary malignant lesions found in two patients were considered metastatic because of the presence of mediastinal nodes or systemic involvement. One patient with an unresectable NSCLC, two with a resectable NSCLC, and one with SCLC had severe dysplasia. The detection rate for cancerous lesions by the clinician was 6.0% (6/99) including AFB compared with 3.0% (3/99) with WLB alone. The prevalence of definite synchronized cancer was 4.0% (4/99) after using AFB compared with 2.0% (2/99) before, and the staging-up effect was 1.0% (1/99) after AFB. Since the majority of patients were diagnosed with advanced disease, the subjects with newly detected cancerous lesions did not have their treatment plans altered, except for one patient with a stage-up IV NSCLC who did not undergo radiotherapy. Conclusions: Additional AFB is effective in detecting early secondary cancerous lesions and is a more precise tool in the staging workup of patients with primary lung cancer than with WLB alone.

연구 배경 : 새로이 폐암으로 진단되는 환자에 대하여 기존 백색빛 기관지 내시경 검사에 더하여 자가 형광 기관지 내시경 시행 시, 2차성 동시성 원발성 폐암 및 전암성 병변의 발견율 향상의 정도를 알아 보고자 연구를 계획하였다. 방 법 : 2005년 1월부터 12월까지 충남대학교 병원에서 폐암으로 진단되는 환자를 대상으로 백색빛 기관지 내시경 시행 후 날짜를 달리하여 형광기관지 내시경을 시행하여, 원발성 병변과는 해부학적으로 다른 부위에 내시경 소견상 이상이 있는 경우 모두 조직검사를 시행하여 확인하였다. 결 과 : 새로이 폐암으로 진단되는 99명에 대하여 백색빛 기관지 내시경 및 자가 형광 기관지 내시경이 시행되었고,. 이들 중 46명의 환자에 대하여 84곳의 조직검사가 시행되었다. 이차성 암성 병변의 경우 6명의 환자에서 확인이 가능하였고, 이중 동시성 폐암으로 판단한 환자는 4명(4.0%)으로 모두 절제 불가능한 1차성 병변을 가지고 있는 환자이었고, 전이성 폐암으로 판단한 환자는 2명(2.0%)이었으며, 이 중 한명은 IIIB병기에서 IV병기로 병기상승을 가져왔다. 전암성 병변인 중증 이형성증은 초기 절제 가능한 비소세 폐암 환자 중 2명, 절제 불가능한 비소세포 폐암 환자 중 1명, 1명의 소세포 폐암 환자에서 발견 되었다(4/99, 4.0%). 자가 형광 기관지 내시경 시행 전과 후의 발견율의 차이는, 이차성 암성 병변의 경우 3명(3%)에서 6명(6%)으로, 동시성 폐암만 살펴 보았을 경우 2명(2.0%)에서 4명(4.0%)으로 향상되었고, 중증 이형성증은 모두 자가 형광 기관지 내시경 시행 후에만 발견되었다. 이러한 이차성 암성 병변이 치료에 미치는 영향은 거의 없었는데, 이는 대부분이 수술적 치료가 불가능한 진행된 1차성 병변을 가진 환자에서 발견되었기 때문이었다. 결 론 : 자가 형광 기관지 내시경은 2차성 초기 암성내지 전암성 병변의 발견율 향상에는 백색빛 기관지 내시경 단독 검사보다 우수하나, 전체 폐암환자에서 진단 시 치료에 미치는 영향은 미미하였다.

Keywords

References

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