胃癌の深達度診断—通常内視鏡診断

Depth Diagnosis of Gastric Cancer：Conventional Endoscopic Diagnosis

要旨●NBIなどの狭帯強調画像の開発により，消化管内視鏡検査の診断能は格段に向上した．一方で，多彩な病理組織像を示す胃癌における深達度診断では，依然として通常観察（白色光）の重要性が高い．本稿では，まずESDの適応か否かを判断するうえで重要な粘膜下層浸潤癌に重点を置き，内視鏡所見と病理組織学的所見を対比することで，その代表的な特徴を明らかにする．これにより，通常観察による粘膜下層浸潤癌の診断能向上を目指す．また，進行癌については粘膜下層以深への進展に関する内視鏡所見を提示し，術式決定に寄与する診断の重要性を示す．

　Diagnostic capabilities of gastrointestinal endoscopy have greatly improved after the development of narrow-band imaging（NBI）and other enhanced imaging techniques. However, gastric cancer exhibits diverse histological features, and conventional white-light endoscopy remains highly important, particularly for assessing the depth of invasion. This article focuses on submucosal invasive cancer, which is important for delineating the appropriate indications for endoscopic submucosal dissection（ESD）. This study aims to clarify the characteristic findings of submucosal invasive cancer and improve the diagnostic accuracy of conventional white-light endoscopy by comparing endoscopic findings with histopathological features. In addition, the endoscopic findings of advanced gastric cancer involving invasion beyond the submucosal layer have been discussed with an emphasis on the importance of these evaluations in guiding surgical decision-making.