contact endoscopyが拓く食道ヨード不染帯の鑑別

Endoscopic Diagnosis of Iodine Unstained Areas Observed by Endo-cytoscopy

要旨　生体内で色素法併用拡大内視鏡観察で生きた細胞が観察可能なEndo-cytoscopy systemが開発された．当院にて第1例目の生体内観察が行われ，食道癌10例に生体内観察を行い，正常と癌の明瞭な相違を認識しうることを確認した．臨床応用に先立ち，食道切除ホルマリン固定検体28例78か所の不染部の観察を行った．観察に値する画像が得られた57か所の観察で癌部，正常類似，その中間と主に3つに分類され，それぞれを癌，反応性変化，異型上皮or高度炎症性変化とすると正診率は89％で，癌か非癌かでは91％であった．粘膜癌の診断において生検診断にせまる診断が可能で治療すべきヨード不染の鑑別に期待が持てる．

　A project to observe living cancer cells in vivo has supplied us with an “Endo-cytoscopy” prototype from Olympus, Tokyo. Ten cases of squamous cell carcinoma were observed, enabling us to detect the difference between the cancer and normal mucosa in vivo. Subsequently, we observed 28 cases and 78 iodine unstained areas of formalin fixed resected specimens of the esophagus. 57 areas were able to be evaluated. The Endo-cytoscopy views were classified into 3 types. Type A : N/C ratio was low and the density of the cells was low. Type B : N/C ratio was low and the density of the cells was high. Type C : N/C ratio was high and the density of the cells was high. Type A was characteristic of reactive change. Type B was characteristic of atypical epithelium or high grade inflammatory change. Type C was characteristic of squamous cell carcinoma. It's accuracy rate was 89％. Endo-cytoscopy is useful for distinguishing carcinoma from non-carcinoma.