IEEによる食道癌診断の最前線

Recent Advances in Image-Enhanced Endoscopy for Diagnosing Esophageal Carcinoma

要旨●本総説では，食道癌診断における画像強調内視鏡（IEE）の最新動向について概説する．従来の通常観察（白色光）やルゴール染色の限界を背景に，NBIを中心としたIEE観察は，病変の検出から質的診断，さらには深達度診断までを担う中核技術へと発展している．特に食道扁平上皮癌では微小血管構築像の評価が重要であり，腺癌では粘膜構造と血管の規則性の破綻が診断の鍵となる．さらにTXIやLCIは病変検出能を高め，RDIは治療支援に寄与する．これら各モダリティを段階的に統合することが診断精度の向上に重要であり，今後は複合モードやAIとの融合によるさらなる発展が期待される．

　This review outlines the latest advances in image-enhanced endoscopy（IEE）for the diagnosis of esophageal cancer. IEE techniques overcome the limitations of conventional white-light imaging and Lugol chromoendoscopy in esophageal cancer assessment, thus making IEE, particularly narrow-band imaging endoscopy, a core modality for lesion detection, qualitative assessment, and depth-of-invasion diagnosis. In esophageal squamous cell carcinoma, evaluation of microvascular architecture is essential, whereas in adenocarcinoma, disruption of regular mucosal architecture and vascular patterns represents a key diagnostic feature.［Author1］ Texture and color enhancement imaging and linked color imaging improve lesion detection, whereas red dichromatic imaging contributes to therapeutic support［Author2］. A stepwise integration of these modalities is crucial for improving diagnostic accuracy. Further advances are expected through the development of combined imaging modes and integration with artificial intelligence.