Review Article pissn 1738-2637 / eissn 2288-2928 J Korean Soc Radiol 2015;73(6):347-356 http://dx.doi.org/10.3348/jksr.2015.73.6.347 Radiologic Diagnosis of Asbestos-Related Lung Cancer 석면관련폐암의영상진단 Yoon Kyung Kim, MD 1, Jeung Sook Kim, MD 2 *, Yookyung Kim, MD 3 1 Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea 2 Department of Radiology, Dongguk University Ilsan Hospital, Goyang, Korea 3 Department of Radiology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Korea Asbestos was previously widely used due to its many favorable characteristics, such as durability, flexibility, and inexpensiveness. Asbestos has been prohibited in Korea since 2009, however, asbestos-related diseases remain an important public health issue because of its long latency time. Lung cancer is one of the most harmful asbestos-related diseases and patients with asbestos-related lung cancer receive compensation by law. The diagnosis of asbestos-related diseases is based on a detailed interview regarding the asbestos exposure, in addition to clinical, radiological, pathological, and laboratory data. This review provides a radiologic diagnosis of asbestos-related lung cancer. Index terms Lung Cancer Asbestos CT Received April 15, 2015 Revised June 1, 2015 Accepted July 14, 2015 *Corresponding author: Jeung Sook Kim, MD Department of Radiology, Dongguk University Ilsan Hospital, 27 Dongguk-ro, Ilsandong-gu, Goyang 10326, Korea. Tel. 82-31-961-7823 Fax. 82-31-961-8281 E-mail: jeungkim@dumc.or.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서론 석면은잘알려진발암물질로악성중피종이나폐암의발생과관련이있으며악성질환외에도석면폐증이나흉막반, 미만성흉막비후, 흉수등의다양한흉부질환을일으킬수있다 (1, 2). 이러한이유로우리나라에서는 1997 년일부석면의수입및제조를금지하였으며 2009 년석면함유제품의제조및수입, 사용이전면금지되면서직업성석면노출의위험은줄어들었다고볼수있다. 그러나, 석면은최초노출로부터질환이발생하기까지긴인체잠복기간을가지며석면관련업에종사하지않았더라도오래된건축물에거주하거나과거석면함유제품의사용등에의한노출로인해향후 3~40 년간은석면관련질환이지속적으로증가할것으로예상된다 (3). 석면관련질환중건강에가장심각한위해를끼치는질환은악성중피종과폐암이라고할수있다. 악성중피종은폐암에비해발생률이현저히낮고대부분이석면에의해발생하는것으로알려져있어진단받는환자의다수가피해구제신청및보상을받게되는데반해, 폐암은석면과관련된발생원인이규명되어있지않으며석면노출력이 없는일반인에게서빈번하게발생하고폐암자체의영상의학, 병리학, 임상소견은비석면관련폐암과의구별이불가능하다고알려져있어구제신청이나피해인정이쉽지않다. 폐암진단시석면관련성을염두에두지않으면석면노출과관련된영상소견이나병리소견을간과할수있으며임상의사역시환자의직업력뿐만아니라거주력까지도면밀히조사하지않으면석면노출여부를밝혀내기어렵다. 향후석면관련질환자의수가늘어나고석면관련폐암의피해구제를위한판정이중요해질수있어각병원에서영상의학과의사들이석면질환환자에서발생한폐암의영상소견에대해잘이해할필요가있다. 따라서이논문에서는석면관련폐암의국내현황과인정기준, 영상진단에대해설명하고자한다. 석면관련폐암 석면관련폐암은전체폐암의약 3~8% 를차지한다고알려져있다 (4). 1990 년대이전에발표된연구들에서는흡연과관련하여발생하는일반적인폐암이폐의상엽에주로편평상피 Copyrights 2015 The Korean Society of Radiology 347
석면관련폐암의영상진단 암으로발생하는데반해석면관련폐암은석면폐증, 즉석면과관련된폐섬유화가빈발하는폐하엽에선암의형태로더많이발생한다고보고하여발생부위나병리아형으로폐암의석면관련성을구별하려는노력이있었다 (5, 6). 그러나이러한연구들은제한된환자수를대상으로한후향적연구로선택편향 (selection bias) 이의심된다. 1997 년발표된 4060 명의석면노출근로자와 14254 명의중증흡연자를대상으로한대규모의연구에따르면석면노출그룹에서 78 명, 흡연그룹에서 214 명의폐암환자가발생하였으며석면노출그룹에서 33%, 흡연그룹에서 20% 로석면노출그룹에서유의하게하엽에폐암이발생하는경향이있었으나 ( 오즈비 = 1.96, 신뢰구간 = 1.03~3.55) 두그룹모두상엽에서폐암이더많이발생하였다. 또한석면노출그룹에서흉부 X-선사진에서폐섬유화가보이는환자와그렇지않은환자사이에폐암발생부위의차이는없었다. 석면노출그룹과흡연그룹에서모두폐선암이가장많이발행하였고 (32% 대 30%) 편평상피암은석면노출그룹에서는 32% 로폐선암과비슷한반면흡연그룹에서는 20% 로적었다. 대세포암과소세포암은각각 16% 대 24%, 15% 대 21% 로흡연그룹에서더많이발생하였다 (7). 일본에서 2003 년에 120 명의석면관련폐암환자들을대상으로시행한연구에따르면편평상피암 45%, 선암 42.5%, 소세포암 9.2%, 대세포암 3.3% 의순서로발생하였다 (1). 2014 년까지시행된잘설계된연구결과들을종합한메타분석결과에의하면석면관련폐암은비석면관련폐암과비교하여발생부위및병리아형에차이가없다고하였다 (4, 8). 석면관련폐암의예후에관하여는많은연구가이루어져있지않은데, 422 명의폐암환자를대상으로한한연구에서는 25% 가석면노출력이있었으며 5년생존율은 9% 로석면관련폐암과비석면관련폐암간에차이가없다고하였다 (8). 예후는유사하지만동반된석면폐증이나흉막반에의한제한성효과 (restrictive effect) 때문에폐기능장애로수술이불가능한경우가발생할수있다. 석면관련폐암의암생성기전은아직까지명확하지않다. 석면누적노출량과폐암발생위험성이선형적연관관계가있다고알려져있으나석면누적노출량외에도다른폐암위험요인에영향을받을수있다. 석면폐증이폐암발생의전구질환인지의여부역시아직까지논란이있다. 석면노출자중에도흡연력이있는경우가많은데, 흡연은석면노출자의폐암위험성을증가시키지만흡연과상관없이석면자체로폐암의위험이증가하는것으로되어있으며개별사례에서흡연과석면의영향이각각어느정도인지밝히는것은매우어려우므로흡연여부와관계없이석면에상당량노출된폐암환자라면석면관련폐암으로인정받게된다 (3, 4, 9). 석면관련폐암의국내현황과보상제도 우리나라에서는 1994년에최초로 11년간단열재공장에서근무한 61 세남자에서석면폐증에동반된폐암이직업성암으로인정된이후로주물공장, 조선소, 석면방직공장등에서일했던근로자들에게서발생한석면관련폐암이보고되어왔다. 2014 년보고에의하면 1994 년 1명으로시작해서 2011년 13 명까지총 87 명의폐암환자가석면과관련된직업성폐암으로인정을받았으며점차로증가하는추세라고볼수있다 (10-15). 직업적인노출외에도석면방직공장이나석면광산등석면분진이많이발생하는석면산업의경우주변거주자에게도석면피해를일으킬수있어환경성석면노출에의한석면관련질환역시증가하는추세이다 (15). 석면관련작업장에서근무한근로자의경우산업재해보상보험법에따라산재보상을받을수있다. 그러나석면광산이나석면공장주변의거주자를비롯하여환경적석면노출로인한피해자는마땅한보상을받지못하는경우가많아이러한사람들을구제하기위한제도가필요하게되었다. 따라서우리나라에서는 2011년부터환경성석면노출로인한석면관련질환을구제하는석면피해구제법이시행되었다. 석면관련작 Table 1. Helsinki Criteria for Evaluating Asbestos Related Lung Cancer 1. The presence of asbestosis (e.g., asbestosis diagnosed clinically, radiologically using high-resolution CT or histologically). 2. A count of 5000 to 15000 asbestos bodies (ABs) or more per gram of dry lung tissue (/g dry), or an equivalent uncoated fiber burden of 2.0 million or more amphibole fibers (> 5 µm in length)/g dry, or 5.0 million or more amphibole fibers > 1 µm in length/g dry; this tissue count of ABs is also roughly equivalent to 5 15 ABs/mL of bronchoalveolar lavage (BAL) fluid. 3. Estimated cumulative exposure to asbestos of 25 fiber-years or more. 4. An occupational history, the only means whereby latency can be evaluated, of 1 year of heavy exposure to asbestos (e.g., manufacture of asbestos products, asbestos spraying, insulation work with asbestos materials, demolition of old buildings) or 5 10 years of moderate exposure (e.g., construction or shipbuilding). The criteria go on to state that a 2-fold risk of lung cancer can be reached with exposures less than 1 year in duration if the exposure is of extremely high intensity (e.g., spraying of asbestos insulation materials). 5. A minimum lag-time of 10 years. Criteria for acceptance: one of (1 4) and 5 348 대한영상의학회지 2015;73(6):347-356 jksronline.org
김윤경외 업장에서근무했던증거자료가불충분하여산업재해보상보험 법을통해보상받지못한근로자나, 직업력은없더라도석면공 장또는석면광산인근에거주하여환경적인노출이의심되는 경우환자나유족이각거주지의지방자치단체를통해환경공 단에석면피해구제보상신청을하면석면피해판정위원회의심 사를거쳐피해인정여부가결정된다. 만약석면피해판정위원회 Table 2. Criteria for Acceptance of Asbestos Related Lung Cancer in Asbestos Damage Relief Act in Korea A. In any of the following events 1) A biopsy and microscopic examination 2) Clinical and radiological evaluation (in case of no availability of biopsy and microscopic examination) B. If medical decision falls within any of sections 1 3 1) Asbestosis 2) Pleural plaque 3) Asbestos bodies or fibers in dry lung or bronchoalveolar lavage fluid Criteria for acceptance: 1 and 2. 1 = A and B, 2 = latency and substantial exposure 의심사결과불인정되었다면석면피해심사위원회에재심을신청할수있으며, 여기에서도불인정판정을받는다면석면피해재심사위원회에 3심을신청할수있다 (2). 각위원회는영상의학과, 병리과, 직업환경의학과, 호흡기내과전문의와법률가등으로구성되어있으며신청자가제출한진단서, 조직병리검사결과서, 흉부전산화단층촬영사진, 석면노출력확인질문서등을검토한후합의를통해인정여부를결정한다. 피해인정을받으면요양생활수당과요양급여가지급되고사망하였을경우장의비및유족조위금이지급된다. 2011년부터 2014 년까지 4년간석면피해구제를신청한폐암은총 443 건이며이중 138 명의환자또는유족이석면피해구제법에의해석면관련폐암으로인정받았다 (16). 석면관련폐암의인정기준 대부분의국가에서폐암의석면관련성을인정하는데있어서 A B C D E Fig. 1. Representative CT images of asbestosis; specific (A-C) and nonspecific (D-F) findings. A. Subpleural dot-like and branching opacities. B. Subpleural curvilinear opacities. C. Parenchymal band. D. Intralobular interstitial thickening (arrows). E. Intralobular interstitial thickening (arrows) and interlobular septal thickening. F. Honeycombing. F jksronline.org 대한영상의학회지 2015;73(6):347-356 349
석면관련폐암의영상진단 헬싱키기준 (Helsinki criteria) 을사용한다 (17-20). 헬싱키기준에따르면석면관련폐암으로인정받기위해서는최초노출시점으로부터최소잠복기 10 년이상인폐암환자에서 1) 석면폐증이확인되거나 ( 임상적, 조직학적또는영상의학적으로 ), 또는 2) 폐조직이나기관지폐포세척액에서일정기준이상의석면또는석면소체가발견되거나, 또는 3) 누적노출량의예상치가 25 fiber/year 이상이거나, 또는 4) 1년이상의고농도노출 ( 석면공장, 석면뿜칠, 절연체, 오래된건물철거작업 ) 또는 5~10 년의중등도노출 ( 건축, 조선 ) 이인정되는경우이다 (Table 1). 특정환경에서는 1년미만의노출이라하더라도매우고농도의노출인경우폐암위험성을증가시킬수있어판정에있어서는직업환경의학과와호흡기내과, 병리과, 영상의학과전문의의논의가필요하다. 국내에서석면피해구제법에의해석면관련폐암으로인정하는기준은 Table 2와같다 (2). 헬싱키기준과의차이점은상당한정도의노출력이필요조건으로인정되어야한다는것과석면폐증외에도흉막반이인정기준에포함된다는점이다. 폐암환자의거의대부분에서흉부전산화단층촬영이시행되며 현실적으로석면소체나석면폐증의조직학적확인이제한되는경우가많아영상의학적진단이석면관련폐암의인정에매우중요하다고하겠다. 석면관련폐암의영상의학적진단 석면관련폐암의진단에서폐암의확진은조직병리검사결과로이루어진다. 그러나조직검사를시행하지못한경우에는영상의학소견이나진료기록등을근거로하여폐암을진단한다. 석면관련폐암을진단하고병기를결정하기위한검사과정은비석면관련폐암과다르지않으며일반적인비석면관련폐암과마찬가지로석면관련폐암은폐종괴나폐결절, 기관지내종괴등으로나타난다 (7, 21). 석면관련폐암의영상소견에관한연구는폐암자체의영상소견보다는동반된석면폐증이나흉막반에관한연구가대부분이며비석면관련폐암과비교하여석면관련폐암자체의특징적인영상소견은밝혀진바없다. 국내에서 2011년부터 2013 년사이에석면피해구제법을통해석면관련 A B C Fig. 2. Representative CT images of pleural plaque. A. Multiple bilateral plaques. B. Diaphragmatic pleural plaques. C. Noncalcified plaque (arrows). D. Thin plaque (arrows). D 350 대한영상의학회지 2015;73(6):347-356 jksronline.org
김윤경외 폐암으로진단받은 57 예의흉부전산화단층촬영소견을분석한결과폐종괴 34예 (59.6%), 폐결절 10예 (17.5%), 폐경화 1예 (1.8%), 기관지내종괴 1예 (1.8%) 로나타났으며, 11예 (19.3%) 는수술또는치료전영상이없어서판단이불가능하였다. 석면관련폐암의영상의학적진단에있어서가장중요한것은석면노출력을시사하는소견인석면폐증이나흉막반의발견이다. 흉막반이나석면폐증을진단함에있어서단순흉부촬영에비해고해상도전산화단층촬영의민감도가높음은잘알려 져있다 (22). 석면폐증의존재는고농도의석면노출을시사하며폐암의위험도증가와관련이있다 (23). 고해상전산화단층촬영에서석면폐증은초기에가슴막밑점같은혼탁 (subpleural dotlike opacities) 및가슴막밑곡선음영 (subpleural curvilinear opacities) 으로보인다. 점차진행되어소엽내간질비후 (intralobular intersititial thickening or intralobular lines) 와소엽간중격비후 (interlobular septal thickening) 가보일수있으며섬유화가좀더 A B C D Fig. 3. A 67-year-old male who had been a slate factory worker for 20 years. Chest PA (A) and lateral (B) views show a mass in the left middle lung zone. Pleural plaques (arrows) are seen along the right lateral chest wall and diaphragmatic pleura. Axial (C) and coronal (D) CT images show a lobulated mass with heterogeneous enhancement in left upper lobe and pleural plaques (arrows) in both hemithoraces. The mass was diagnosed as squamous cell carcinoma by percutaneous needle biopsy. jksronline.org 대한영상의학회지 2015;73(6):347-356 351
석면관련폐암의영상진단 Table 3. Radiologic Diagnostic Guideline of Asbestos-Related Lung Cancer Pleural Plaque Asbestosis Approval Specific Specific Approval Nonspecific fibrosis None Approval Approval Equivocal Specific Approval Nonspecific fibrosis None None Specific Approval Nonspecific fibrosis None Refer to exposure history Refer to exposure history Refer to exposure history Refer to exposure history 진행되면폐실질밴드 (parenchymal bands), 벌집모양음영 (honeycombing), 견인성기관지확장증 (traction bronchiectasis) 이관찰된다 (Fig. 1). 이러한소견은폐하부후방기저부가슴막밑에주로생기고진행되면폐중부와상부까지확장된다 (24, 25). 그러나석면폐증은다른원인에의한폐섬유화나특발폐섬유증 (idiopathic pulmonary fibrosis) 과구별하기어렵다. Akira 등 (26) 의연구에따르면가슴막밑점같은혼탁, 가슴막밑곡선음영, 모자이크관류 (mosaic perfusion), 그리고폐실질밴드가특발폐섬유증보다석면폐증에서유의하게더많이나타나는소견이다. 반면육안으로관찰되는소엽내세기관지 (visible intralobular bronchioles), 섬유성폐경화내세기관지확장증 (bron- A B C D E Fig. 4. A 74-year-old male who had been asbestos mine worker for 5 years and resided near the asbestos mine for 27 years. Forty-four years after his initial exposure to asbestos, large cell neuroendocrine carcinoma developed in the right middle lobe (A). Calcified pleural plaques are seen in both hemithoraces and diaphragms (A, B). On lung window setting images (C-E), parenchymal bands and intralobular interstitial thickening suggestive of asbestosis (arrows) are noted adjacent the plaques. 352 대한영상의학회지 2015;73(6):347-356 jksronline.org
김윤경외 chiolectasis within fibrotic consolidations), 벌집모양음영이석면폐증보다특발폐섬유증에서더많이나타나는소견이라고하였다. 폐암환자의고해상흉부전산화단층촬영영상에서석면폐증의특징적인소견인가슴막밑점같은혼탁이나가슴막밑곡선음영, 폐실질밴드등이발견되면석면관련폐암을고려해보아야하며석면노출력이알려져있다거나흉막반이뚜렷이보이는환자라면비특이적인폐섬유화의소견일지라도석면폐증일수있으며석면관련폐암의가능성을고려해볼수있다. 다만석면폐증의특이적인초기소견들은고해상흉부전산화단층촬영영상또는복와위 (prone position) 영상이아닌경우확인이어려워폐암환자의일반흉부전산화단층촬영영상에서는간과할수있다. 그러므로가능하다면추가적인재구성영상을얻거나재촬영을하는것이정확한진단에도움이된다. 흉막반은양성석면관련질환중가장흔하며석면노출근로자의최대 58% 에서, 환경적노출을받은사람의 8% 에서발견된다는보고가있다 (4, 9). 흉막반의존재는석면에노출되었다는근거가되므로폐암환자의전산화단층촬영영상에서흉막반을찾는것은매우중요하지만, 낮은농도의석면노출에도흉막반이발생할수있어서흉막반과폐암의관계는아직까지논란이있다. 2014 년개정된헬싱키기준에의하면아직까지는노출력이확인되지않은상태에서흉막반의존재단독으로는석면관련폐암으로단정지을수없다고하고있다 (17, 18, 20, 27). 최근연구에서는 Pairon 등 (27) 이 5800 여명의석면관련질환코호트남성을대상으로흉부전산화단층촬영을시행한연구에서흉막반이폐암의독립적인위험인자라고주장한바있다. 흉막반의전형적인영상소견은양측에다발성으로보이는국 소흉막비후인데다양한크기와모양, 숫자를보일수있고때로는단일성병변이나혹은한쪽흉곽에서만나타나기도한다. 가장흔한위치는등쪽흉곽하부에가장호발하며특징적으로횡격막이나비의존성위치 (nondependent area) 에서관찰된다 (Fig. 2). 대부분흉막하연부조직과뚜렷한경계를보이며시간이지날수록두꺼워지고석회화가진행된다 (9). 석면관련흉막반은결핵성흉막비후및석회화와감별이필요한데결핵성흉막비후는주로흉벽하후방중에서도의존성위치에호발하고늑가로막의둔화를동반하며가로막이나비의존성위치의흉막비후는드물다. 폐암환자의전산화단층촬영영상에서전형적인석면관련흉막반이발견되었다면석면노출이입증되었다고볼수있으므로석면관련폐암의가능성이있으며노출력이나석면폐증의동반유무를확인해보아야한다 (Fig. 3). 양측성미만성흉막비후는중등도부터고농도의석면노출을시사하는소견으로석면관련폐암에미치는영향은석면폐증과유사할것으로간주된다 (18). 석면에의한미만성흉막비후는발생빈도는높지않으나호흡기능장애를유발할수있다. 석면질환외에도다양한원인에의해발생할수있으며영상소견이비특이적이어서다른원인에의한미만성흉막비후와영상소견만으로감별하는것은불가능하다. 미만성흉막비후의영상의학적정의는늑막가로막각의둔화가동반된흉막비후로너비 5 cm 이상, 상하방향범위가 8 cm 이상, 두께가 3 mm 이상일때를말한다. 영상의학과전문의로서폐암의석면관련성을판정할경우에는비특이적인섬유화나흉막비후라할지라도세심하게관찰하고환자의직업력및노출력을면밀히검토하여결정하는것이바람직하다 (Table 3, Figs. 4, 5). A B C Fig. 5. A 55-year-old male with squamous cell carcinoma in the left upper lobe. He was a construction worker for 24 years. Coronal reformatted image (A) shows a mass suggestive of lung cancer in the left upper lobe. Axial images (B, C) show honeycombing in both subpleural lungs, predominantly in the lower lung zones. In the area of less severe fibrosis, subpleural dot-like opacities, suggestive of early findings of asbestosis, are seen (arrows). jksronline.org 대한영상의학회지 2015;73(6):347-356 353
석면관련폐암의영상진단 향후고려사항 폐암의조기발견과치료는병기를낮추고이는생존율과직접적인관계가있다. 미국에서시행된대규모의무작위배정임상시험 (National Lung Screening Trial) 에서폐암고위험군에서저선량흉부전산화단층촬영을이용한폐암검진이사망률을감소시켰다고보고되었으며이는석면노출력이있는사람에있어서도유사한정도의폐암의조기발견과사망률감소에기여할수있을것으로예상된다 (4, 28, 29). 또한석면노출자를대상으로검진으로시행한흉부전산화단층촬영에서보이는석면폐증이나흉막반의소견이향후사망을예측함에있어유의한소견이라는연구결과도있다 (30, 31). 현재까지국내에서는석면노출자를대상으로한폐암검진은시행되고있지않지만향후석면관련질환이증가할것으로예상되는점과폐암환자역시증가하고있음을고려해볼때영상의학과전문의로서석면관련질환의영상소견을숙지하고있는것은중요하다고하겠다. 더욱이직업성석면노출뿐만아니라환경적노출에의해서도석면관련질환이발생할수있기때문에환자스스로가본인이석면에노출된사실을정확히모르는상태에서흉부영상을접하는영상의학과의사가석면노출가능성을먼저제시해줄수있다면폐암환자의경우향후피해신청이나보상에도움을줄수있을것이며폐암환자가아니라면금연이나검진을권고함으로써폐암예방또는조기발견에도움을줄수있을것이다. Acknowledgments This research was supported by the Korea Ministry of Environment under The Environmental Health Action program. REFERENCES 1. Kishimoto T, Ohnishi K, Saito Y. Clinical study of asbestosrelated lung cancer. Ind Health 2003;41:94-100 2. Kang DM, Kim YK, Kim JE. Asbestos and environmental diseases. J Korean Med Assoc 2012;55:214-222 3. Kim SG. Compensation and diagnosis of asbestos related disease. Korean J Fam Med 2009;30:335-343 4. Prazakova S, Thomas PS, Sandrini A, Yates DH. Asbestos and the lung in the 21st century: an update. Clin Respir J 2014; 8:1-10 5. Karjalainen A, Anttila S, Heikkilä L, Kyyrönen P, Vainio H. Lobe of origin of lung cancer among asbestos-exposed patients with or without diffuse interstitial fibrosis. Scand J Work Environ Health 1993;19:102-107 6. Auerbach O, Garfinkel L, Parks VR, Conston AS, Galdi VA, Joubert L. Histologic type of lung cancer and asbestos exposure. Cancer 1984;54:3017-3021 7. Brodkin CA, McCullough J, Stover B, Balmes J, Hammar S, Omenn GS, et al. Lobe of origin and histologic type of lung cancer associated with asbestos exposure in the Carotene and Retinol Efficacy Trial (CARET). Am J Ind Med 1997;32: 582-591 8. Nielsen LS, Bælum J, Rasmussen J, Dahl S, Olsen KE, Albin M, et al. Occupational asbestos exposure and lung cancer--a systematic review of the literature. Arch Environ Occup Health 2014;69:191-206 9. Roach HD, Davies GJ, Attanoos R, Crane M, Adams H, Phillips S. Asbestos: when the dust settles an imaging review of asbestos-related disease. Radiographics 2002;22 Spec No: S167-S184 10. Jung JY, Ahn HS, Kim JW, Kim KA, Yun IG, Kim HW, et al. A case of asbestosis, pleural effusion and lung cancer caused by longterm occupational asbestos exposure. Tuberc Respir Dis 1994;41:651-657 11. Ahn YS, Jeong KS. Epidemiologic characteristics of compensated occupational lung cancers among Korean workers. J Korean Med Sci 2014;29:1473-1481 12. Ahn YS, Song JS, Kang SK, Chung HK. Understanding the occurrence of lung cancer in foundry workers through health insurance data. Korean J Prev Med 2000;33:299-305 13. Yoon DY, Kang JW, Lee HJ, Kim JI, Son JE, Jung KY, et al. A case of lung cancer caused by long-term asbestos exposure. Korean J Occup Environ Med 2004;16:499-507 14. Lim JW, Park SY, Choi BS. Characteristics of occupational lung cancer from 1999 to 2005. Korean J Occup Environ Med 2010;22:230-239 15. Kang DM, Gu DC, Kim KH. Asbestos-related diseases among asbestos textile factory workers and residents around the factory. J Korean Med Assoc 2009;52:482-488 16. Asbestos Damage Relief Center Homepage (https://www. adrc.or.kr). Notice 52, Current status of asbestos damage relief judgment and certification. Incheon: Korea Environment Corporation, 2015 17. Tossavainen A. Asbestos, asbestosis, and cancer: the Helsinki criteria for diagnosis and attribution. Scand J Work Environ 354 대한영상의학회지 2015;73(6):347-356 jksronline.org
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석면관련폐암의영상진단 석면관련폐암의영상진단 김윤경 1 김정숙 2 * 김유경 3 석면은가공하기쉬운특성과저렴한가격때문에건축이나각종제품의생산에광범위하게사용되었다. 현재는석면에의한건강피해가알려져사용이제한되었지만인체내에서의긴잠복기를가지므로향후석면관련질환은계속증가할것으로예상된다. 석면관련질환중폐암은조기에발견하지않으면예후가나빠생존율이매우낮은병으로폐암의석면관련성이인정되면피해보상을받을수있다. 석면관련폐암은직업환경의학과, 병리과, 호흡기내과, 영상의학과전문의등이논의하여인정여부를결정하며이에석면관련폐암의영상의학적진단에대해기술하고자한다. 1 가천대학교길병원영상의학과, 2 동국대학교일산병원영상의학과, 3 이화여자대학교의학전문대학원목동병원영상의학과 356 대한영상의학회지 2015;73(6):347-356 jksronline.org