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Stomach and Intestine(Tokyo) Volume 49, Issue 8 （July 2014）

胃と腸 49巻8号（2014年7月発行）

Japanese English

今月の主題表面型表層拡大型食道癌の診断と治療戦略

主題

表面型表層拡大型食道癌の深達度診断―内視鏡の立場から Usefulness of NBI Magnifying Endoscopy for the Diagnosis of Invasion Depth of Superficially Spreading Esophageal Squamous Cell Carcinoma 竹内学 ¹ , 橋本哲 ² , 小林正明 ² , 渡辺玄 ³ , 水野研一 ² , 佐藤祐一 ¹ , 味岡洋一 ³ , 青栁豊 ¹ Manabu Takeuchi ¹ , Satoru Hashimoto ² , Masaaki Kobayashi ² , Gen Watanabe ³ , Ken-ichi Mizuno ² , Yuichi Sato ¹ , Yoichi Ajioka ³ , Yutaka Aoyagi ¹ ¹新潟大学医歯学総合病院消化器内科 ²新潟大学医歯学総合病院光学医療診療部 ³新潟大学大学院医歯学総合研究科分子診断病理学分野 ¹Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata, Japan ²Department of Endoscopy, Niigata University Medical and Dental Hospital, Niigata, Japan ³Division of Molecular and Diagnostic Pathology, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan キーワード：食道表在癌 , 表層拡大型 , 深達度 , 拡大内視鏡 , NBI Keyword: 食道表在癌 , 表層拡大型 , 深達度 , 拡大内視鏡 , NBI pp.1157-1163

発行日 2014年7月25日 Published Date 2014/7/25

DOI https://doi.org/10.11477/mf.1403114225

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参考文献 Reference

要旨　表面型表層拡大型食道癌63病変に対し，通常・色素内視鏡および日本食道学会拡大内視鏡分類を用いたNBI併用拡大内視鏡観察による深達度正診率を検討した．正診率は通常・色素内視鏡観察では66.7％（42/63），NBI併用拡大内視鏡観察では76.2％（48/63）であり，約10％の上乗せ効果を認めた．特に，T1a-MM/T1b-SM1癌の正診率は12％から60％に飛躍的に向上した．しかし，NBI併用拡大観察による誤診例の多くは表層をT1a-EP/LPM癌が被覆する病変であり，関心領域同定後に通常・色素内視鏡観察で病変の厚みや硬さを再度確認し，総合的に深達度診断を行う必要があると考えた．

　Misdiagnosis of the depth of tumor invasion in patients with superficially spreading ESCC（esophageal squamous cell carcinoma）is likely because of difficulty in detailed observation of the lesions. The accuracy of invasion depth assessments in patients with superficially spreading ESCC was evaluated by conventional/chromoendoscopy and NBI（narrow-band imaging）magnifying endoscopy at our institute. Sixty-three consecutive lesions diagnosed as ESCC and treated by endoscopic submucosal dissection were evaluated from November 2006 to August 2013. The overall accuracy of conventional/chromoendoscopy was 66.7％（42/63）, and the reason for misdiagnosis was underestimation of the depth of invasion because of uneven lesions. On the other hand, the overall accuracy of NBI magnifying endoscopy was 76.2％（48/63）, and the positive effect was approximately 10％. In particular, the rate of diagnosis of T1a-MM/T1b-SM1 carcinomas was greatly improved. However, most lesions that were misdiagnosed by NBI magnifying endoscopy presented characteristics of T1a-EP/LPM carcinomas on the tumor surfaces. Therefore, estimating the thickness and hardness of the regional area after observing the lesion with NBI magnifying endoscopy may be a better diagnostic strategy.