Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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A Study of the Results of Sputum Cytology as a Special Health Examination

특수건강진단으로 시행된 객담 세포진 검사의 결과에 관한 연구

  • Lee, Jun-Hoo (Department of Occupational &) ;
  • Chae, Chang-Ho (Environmental Medicine, Samsung Changwon Hospital, College of Medicine, Sungkyunkwan University) ;
  • Kim, Young-Wook (Department of Occupational &) ;
  • Son, Jun-Seok (Environmental Medicine, Samsung Changwon Hospital, College of Medicine, Sungkyunkwan University) ;
  • Kim, Ja-Hyeon (Department of Occupational &) ;
  • Park, Seung-Hyun (Environmental Medicine, Samsung Changwon Hospital, College of Medicine, Sungkyunkwan University) ;
  • Cho, Ho-Seong (Department of Occupational &)
  • 이준호 (성균관대학교 의과대학 삼성창원병원 직업환경의학과) ;
  • 채창호 (성균관대학교 의과대학 삼성창원병원 직업환경의학과) ;
  • 김영욱 (성균관대학교 의과대학 삼성창원병원 직업환경의학과) ;
  • 손준석 (성균관대학교 의과대학 삼성창원병원 직업환경의학과) ;
  • 김자현 (성균관대학교 의과대학 삼성창원병원 직업환경의학과) ;
  • 박승현 (성균관대학교 의과대학 삼성창원병원 직업환경의학과) ;
  • 조호성 (성균관대학교 의과대학 삼성창원병원 직업환경의학과)
  • Published : 2011.06.30
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Abstract

Objectives: This study aims investigate the results of sputum cytology, which began its test period from 2009 as a special health examination for individuals whose lungs have been exposed to carcinogens. Methods: 22,215 cases of sputum results were classified into six categories through Papanicolau classification. The sputum results were analyzed according to age, exposure degree to welding fumes and smoking status. Chi-square tests and logistic regression analysis were used to compare and analyze the associations between sputum results and smoking status, exposure degree and age classifications. Results: The number of class I cases was 20,784 with a frequency of (93.6%), class II had 1,076 cases (4.8%), class III had 69 cases (0.3%), and the inadequate class had 286 cases (1.3%) and there were no cases in class VI and V. Patients in class III received CT scans of their chest for further evaluation, but no cancer patients were found from that. There were 2.48 times (95% CI 1.12~5.53) more smokers than non-smokers in class III and 1.70 times (95% CI 1.43~2.02) more in class II. The number of ex-smokers was 2.46 times (95% CI 1.01~5.99) larger than the number of non-smokers in class III and 1.28 times (95% CI 1.03~1.60) larger than the number of non-smokers in class II. There were 1.54 times (95% CI 1.28~1.85) more patients from the mid-exposure group than the low exposure group in class II. There were 1.62 times (95% CI 1.31~1.99) more patients from the high-exposure group than the low-exposure group in class II. Conclusions: As a screening test for lung cancer, the usefulness of sputum cytology is limited. However, the precancerous cells (class II, class III) varied according to welding fume exposure degree and smoking status.

목적: 본 연구는 2009년부터 폐 발암물질에 노출된 근로자에게 특수건강진단에서 시행하는 객담 세포진 검사 결과를 분석하여 객담 세포진검사 결과에 영향을 주는 인자를 파악하고 특수건강진단의 선별 검사로서 객담 세포 진검사의 개선을 위한 기초자료를 제공하고자 하였다. 방법: 2009년 1월 9일부터 2010년 7월 30일까지 일개 조선소에서 시행된 22,215건의 객담 세포진 검사 결과를 Papanicolau 분류에 따라 6개의 등급으로 분류를 하였고, 그 결과를 흡연력, 연령, 및 용접흄에 대한 노출 강도에 따라 카이제곱 검증, 분산분석, 다변량 로지스틱 회귀분석으로 분석 하였다. 결과: 전체 22,215건의 객담 세포진 검사 결과 Class I이 20,784건(93%)으로 가장 많았고, Class II가 1,076건(5.1%), Class III가 69건(0.3%), 검체 불충분이 286건(1.3%)이었다. 하지만, Class IV, V는 1건도 없었다. Class III로 나온 69건은 추가 검사로 흉부 전산화단층촬영을 실시하였는데, 이 중에서 폐암 의심 소견은 없었다. 흡연력에 따른 객담 세포진 검사 결과에서 흡연중인 경우가 비흡연자보다 Class III는 2.48배(95% CI 1.12~5.53), Class II는 1.70배(95% CI 1.43~2.02) 높았다. 과거 흡연자에서는 비흡연자보다 Class III는 2.46배(95% CI 1.01~5.99)배, Class II는 1.28배(95% CI 1.03~1.60)배 높았다. 또한, 용접흄에 대한 노출 정도에 따른 분류에서, Class III에서는 통계적으로 유의하지 않았지만(p>0.05), Class II에서는 저 노출군에 비해서 중간 노출군이 1.54배(95% CI 1.28~1.85), 고 노출군이 1.62배(95% CI 1.31~1.99) 높게 나왔다. 연령 및 근무력에 따라서는 통계적 유의성이 없었다. 결론: 폐 발암물질에 노출된 근로자에 있어서 선별검사로 시행한 22,215건의 객담 세포진 검사에서 폐암은 한 건도 발견되지 않아 유용성은 낮았다. 하지만, 비정형 세포(class III)의 발현은 흡연력에 따라 유의한 차이가 있었고, 상피화생(class II)은 흡연력 및 용접흄에 대한 노출 정도에 따라 유의한 차이가 있었다.

Keywords

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