대장암 선별검사로 시행한 분변잠혈반응검사의 의의
The Significance of Fecal Occult Blood Testing to Screen for Colon Cancer
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목적: 국가 암 검진사업에 대장암이 추가되어 분변잠혈반응검사를 시행하고 있지만, 한국에서 분변잠혈반응검사에 대한 연구는 드물다. 3차 병원 검진센터에서 시행한 분변잠혈반응검사가 대장암 선별검사로서 의의가 있는지를 조사하고자 하였다. 대상 및 방법: 2004년 1월부터 2005년 4월까지 강남성모병원 검진센터를 방문한 검진자의 성적을 후향적으로 분석하였다. 모든 검진자는 분변잠혈반응검사를 위한 대변을 제출하도록 하였고, 추가적으로 하부위장관검사를 원하는 검진자는 검진 당일 결장이중조영촬영을 시행 받았다. 이들 두 검사에서 유소견자와 증상이 있는 환자는 검진일 이후에 소화기 내과에서 결장경검사를 하도록 하였다. 결과: 총 검진자 10,182명 중 8,198명(80.5%)이 대변을 제출하였다. 분변잠혈반응검사 양성 수검자는 149명(1.8%)이었고 연령이 많을수록 높은 양성률을 보였다(p＜0.05). 분변잠혈반응검사 양성 수검자 149명 중 33명(22.1%)이 결장이중조영촬영이나 결장경검사를 시행 받았고, 진단은 대장암 2명(6.1%), 용종 7명(21.2%), 게실 6명(18.3%), 치질 5명(15.2%), 결핵성 장염 1명(3.0%), 정상 12명(36.4%)이었다. 분변잠혈반응검사 음성 수검자 8,049명 중 649명(8.1%)이 결장이중조영촬영이나 결장경검사를 시행 받았고, 진단은 대장암 3명(0.5%), 용종 102명(15.7%), 게실 95명(14.6%), 치질 55명(8.4%), 염증성 장염 6명(0.4%), 정상 388명(59.8%)이었다. 양성 수검자가 음성 수검자보다 대장암과 용종의 진단율이 높았다(p＜0.05). 분변잠혈반응검사의 대장암에 대한 민감도는 40%, 특이도는 95.4%였다. 대장암의 평균연령은 67세로 모두 55세 이상이었다. 결론: 분변잠혈반응검사는 대장암 선별에 유용하지만 민감도가 낮으므로 이를 높이려는 방안이 필요하다.
Abstract
Background/Aims: We investigated the efficacy of the fecal occult blood test (FOBT) as a colon cancer screening tool in a tertiary hospital setting. Methods: This retrospective study analyzed patients who underwent routine check- ups at Kang-Nam St. Mary's Hospital Health Promotion Center from January 2004 to April 2005. All the subjects were encouraged to submit stool for a FOBT, while performing a double contrast barium enema (DCBE) was optional for those who wanted colon examination. Colonoscopy was performed if the FOBT or DCBE results were abnormal or if the patients had bowel symptoms. Results: The FOBT was performed in 8,198 of 10,182 patients (80.5%) who underwent routine check-ups. The overall positive rate of FOBT was 149 of 8,198 (1.8%) and this increased with age (p＜0.05). Colonoscopy and/or DCBE was performed in 33 of 149 patients (22.1%) in the FOBT positive group. Colon cancer and polyp were diagnosed 2 (6.1%) and 7 (21.2%) patients, respectively, in the FOBT positive group, whereas colon cancer and polyp were diagnosed in 3 (0.5%) and 102 (15.7%) patients, respectively, in the FOBT negative group. The sensitivity and specificity of the FOBT for colon cancer was 40% and 95.4%, respectively. Conclusions: Although it had low sensitivity, the FOBT was a useful screening tool for detecting colon cancer in a tertiary hospital setting. (Korean J Gastrointest Endosc 2007;35:68-73)
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