陥凹性小胃癌の鑑別診断―拡大内視鏡と通常内視鏡の対比

Usability of a Magnifying Endoscope in Differential Diagnosis of a Gastric Small Depressed Lesion

要旨　目的：胃小陥凹性病変の鑑別診断における拡大内視鏡の有用性を検討すること．対象と方法：2005年6月から2006年1月の間に拡大観察および生検を施行した胃小陥凹性病変をprospectiveに登録した．通常観察では境界と蚕食像を，拡大観察では血管の口径不同，走行異常および境界をそれぞれgrade-0，1，2にスコア化した．grade-2の所見を有する病変を癌と診断し，通常および拡大診断の精度を比較検討した．結果：18病変が登録され，感度，特異度，生検診断との一致率は，通常診断では29％，75％，39％であり，拡大診断では86％，100％，89％であった．結論：胃小陥凹性病変の鑑別診断に，拡大内視鏡による観察は有用であった．

　Purpose : The objective is to check the usability of a magnifying endoscope in the diagnosis of gastric small depressed lesions.

　Materials and methods : 18 small depressed lesions were enrolled in this prospective study from June, 2005 to January, 2006. These lesions were observed with conventional view and magnifying view and biopsies were taken. Demarcation line and marginal irregularities in the conventional view and micro-vessel architecture in the magnifying view were scored (grade 0-2), and those with grade-2 were diagnosed as cancer.

　Results : Sensitivity, specificity and accuracy was 29％, 75％ and 39％ in the conventional diagnosis, and 86％, 100％ and 89％ in the magnifying diagnosis, respectively.

　Conclusion : The observation of micro-vessel architecture with a magnifying endoscope was useful in the differential diagnosis of small depressed lesions in the stomach.