通常内視鏡診断

White Light Endoscopic Assessment for the Diagnosis of Early-stage Colorectal Cancer

要旨●通常観察による早期大腸癌の深達度診断において，T1b癌の指標となる内視鏡所見として，隆起型では，緊満感，内視鏡的硬さ，凹凸不整，粗糙，皺襞集中，ひきつれ，弧の硬化が，表面型では，それに加えて，陥凹内隆起，陥凹内凹凸，強い発赤，台状挙上，空気変形なし，易出血性が挙げられている．2021〜2024年の期間に当院で切除した早期大腸癌422例451病変において，これらの所見はいずれもTis/T1a癌よりもT1b癌で高い陽性率を示した．すべての所見を認めなかった242病変のうちTis癌が196病変，T1a癌が44病変あり，T1b癌は2病変のみであった．いずれかの所見陽性例では他の所見も含め，総合的にTis/T1a癌を鑑別する必要がある．

　During the determination of invasion depth in early-stage colon cancer using conventional colonoscopy（white-light endoscopy）, findings indicating T1b invasion in patients with protruding lesions included tension findings, endoscopic hardness, uneven irregularities, abrasions, concentrated wrinkles, tightness, and hardening arches. Among 422 patients（451 lesions）with early-stage colorectal cancer who underwent resection at our institution between 2021 and 2024, these findings were more frequent in patients with T1b cancers than in those with Tis/T1a cancers. Among 242 lesions without positive findings, 196, 44, and 2 were diagnosed as Tis, T1a, and T1b cancers, respectively. In cases positive for any of our findings, Tis/T1a cancers must be considered comprehensively, including other findings.