食道扁平上皮癌の内視鏡診断UPDATE

Update on Endoscopic Diagnosis of Esophageal Squamous Cell Carcinoma

要旨●食道表在癌の深達度診断は，リンパ節転移や予後に密接に関連しており，正確な術前診断が求められる．特にMM/SM1およびSM2の判別は治療法を決定するうえで極めて重要である．日本食道学会による拡大内視鏡分類では，JES-B2やJES-B3の診断精度に課題があり，これを改善するために，JES-B2が観察される領域の大きさや肉眼型を考慮した新たな指標の導入が期待されている．また，AIを活用した内視鏡診断により，診断精度を向上させる試みが行われており，将来的には術前診断の精度と客観性がいっそう向上する可能性がある．しかしながら，AIを導入するにあたっては，その限界や課題を十分に理解することが重要である．

　In superficial esophageal cancer, the depth of invasion is closely associated with lymph node metastasis and prognosis, emphasizing the need for accurate preoperative diagnosis. Distinguishing between MM/SM1 and SM2 esophageal cancer is especially critical for selecting appropriate treatment strategies. The magnifying endoscopic classification of the Japan Esophageal Society highlights the limitations of this approach in the diagnostic yield of B2 and B3 vessels. Efforts to address these challenges and improve accuracy include the introduction of new indicators, such as the macroscopic type and the size or location where B2 vessels are observed. Additionally, ongoing studies are using artificial intelligence to enhance diagnostic precision in endoscopic evaluation, which may significantly improve the objectivity and accuracy of preoperative diagnosis. Nonetheless, a thorough understanding of the limitations and challenges of integrating artificial intelligence is essential while fully leveraging the knowledge and expertise developed to date.