악성흉수의 진단과 치료
Diagnosis and Management of Malignant Pleural Effusion
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초록
악성흉수는 거의 모든 악성종양에서 발생할 수 있는 흔히 접하는 임상적 문제이다. 새로운 영상의학적 기법의 소개로 진단의 정확도가 향상되었으나, 확진을 위해서는 악성세포를 세포학적, 조직학적 검사를 통하여 확인하는 것이 필요하다. 환자의 전신상태와 원인 질환에 대한 평가 후 악성흉수에 대한 적절한 치료 방법을 선택하는 것이 중요하겠다(Table 3, Fig. 1). 최근 분자생물학의 발전과 조직학적 진단기술의 발전으로 기존 세포학적, 조직학적 검사의 진단율이 향상되고 있다. 향후 신속하고, 효과적인 진단 방법과 안전하고 효율적인 경화제의 개발이 필요할 것이다. 악성흉수 진단 후에는 보다 적극적인 치료적 중재를 통하여 환자 삶의 질을 향상시킬 수 있도록 노력하여야 하겠다.
Abstract
Malignant pleural effusions (MPEs) are an important clinical problem in patients with neoplastic disease. They can occur as the initial presentation of cancer, a delayed complication in patients with previously diagnosed malignancies, or the first manifestation of cancer recurrence after therapy. Common cancer types causing MPEs include lymphomas, mesotheliomas, and carcinomas of the breast, lung, and ovaries. However, almost all tumor types have been reported to cause MPEs. Regardless of the etiology, the median survival from clinical recognition is 4 months. New imaging modalities assist the evaluation of patients with a suspected MPE. However cytologic or tissue confirmation of malignant cells is necessary to establish a diagnosis. Management of an MPE remains palliative. Managements are directed toward removing pleural fluids and when appropriate, performing pleurodesis or initiating long-term drainage to prevent fluid reaccumulation. Talc pleurodesis is still the choice of treatment although concerns about its safety remain. Several factors such as performance status, expected survival, lung re-expansion following pleural fluid drainage and co-morbidities should be considered before the treatment. (Korean J Med 2011;81:167-173)
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