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Stomach and Intestine(Tokyo) Volume 42, Issue 1 （January 2007）

胃と腸 42巻1号（2007年1月発行）

Japanese English

今月の主題胃分化型SM1癌の診断―垂直浸潤500μm

主題

胃分化型SM1癌（垂直浸潤500μm未満）の診断―500μm以上と対比して―ひだ集中のない陥凹型早期胃癌における内視鏡診断 Endoscopic Diagnosis of Depressed Early Gastric Cancer on Submucosal Invasion Without Converging Hold 草野央 ¹ , 後藤田卓志 ¹ , 小田一郎 ¹ , 池原久朝 ¹ , 松田尚久 ¹ , 斉藤豊 ¹ , 斉藤大三 ¹ , 谷口浩和 ² , 下田忠和 ² Chika Kusano ¹ , Takuji Gotoda ¹ , Ichiro Oda ¹ , Hisatomo Ikehara ¹ , Takahisa Matsuda ¹ , Yutaka Saito ¹ , Daizo Saito ¹ , Hirokazu Taniguchi ² , Tadakazu Shimoda ² ¹国立がんセンター中央病院消化器内視鏡部 ²国立がんセンター中央病院臨床検査部病理 ¹Endoscopy Division, National Cancer Center Hospital, Tokyo ²Pathology of Clinical Laboratory Division, National Cancer Center Hospital, Tokyo キーワード： SM胃癌 , 分化型 , 陥凹型 , 深達度診断 Keyword: SM胃癌 , 分化型 , 陥凹型 , 深達度診断 pp.39-46

発行日 2007年1月25日 Published Date 2007/1/25

DOI https://doi.org/10.11477/mf.1403100382

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要旨　病理組織学的にSM癌と診断された，ひだ集中のない分化型陥凹型早期胃癌294例を対象とし，内視鏡画像の見直し診断により，SM1，SM2癌の内視鏡所見の違いを検討した．SM浸潤部の最大径の平均値は，SM2：10.4mm，SM1：2.6mmとSM1癌では小さな範囲での浸潤であった．SM2癌は，腫瘍径20mm以上の病変，肉眼型では表面複合型，陥凹面の色調では発赤の強い病変，陥凹内結節の有無では結節の存在する病変においてSM1癌に比し多くなっていた．SM2癌は，SM1癌と異なる内視鏡所見を有しており，上記所見はSM2癌を示唆する内視鏡的指標になりえると考えられた．

　To determine the appropriateness of endoscopic resection (ER) of early gastric cancers (EGCs), vertical invasivity should be evaluated before treatment, to exclude the possibility of lymph node metastasis. An expanded criteria based on the risk of lymph node metastasis for ER has been proposed, because of the new development of a technique to dissect the submucosa directly, called ESD (endoscopic submucosal dissection). In expanded criteria, differentiated gastric cancers measuring less than 3cm, without lymphatic vascular involvement, and less than 500μm of submucosal penetration (classified as SM1 according to the Japanese Classification of Gastric Carcinoma) have been included. Because of this, it is important to distinguish macroscopically SM1 invasive EGCs from SM2 invasive EGCs.

　In this study, we reviewed the endoscopic features of 294 depressed EGCs on submucosal invasion, but without converging folds. Cases were divided according to depth of vertical invasion ; SM1 (112 lesions) and SM2 (182 lesions).

　The incidence of SM2 invasive EGCs increased when the size was greater than 2cm. Macroscopically, elevated and depressed type (IIa＋IIc) were found more frequency in the SM2 invasive EGCs (67/182 ; 36.8％). A significant number of the SM2 invasive EGCs showed reddish color (111/182 ; 61.0％), with nodule in the depressed area (63/182 ; 34.6％) in contrast to the SM1 invasive EGCs. Since the incidence of SM2 invasive EGCs increased when the size of the invasive area was greater, the macroscopic differences between SM1 invasive EGCs and SM2 were important.

　It is almost possible to distinguish EGCs with the depth of SM1 from EGCs with the depth of SM2 and the decision about this matter affects which therapy shoud be used.