2．endomicroscopy

Confocal Endomicroscopy for Superficial Esophageal Squamous Cell Carcinoma

要旨　食道表在癌の共焦点内視鏡像について概説した．正常食道粘膜はIPCLに相当する白色の濃いループ状の血管像がみられ，扁平上皮細胞は多綾形として規則正しく配列して観察された．食道表在癌では細胞数が増加して密度が高まり，分布は不規則性を示し，細胞の形もひし形から丸みを帯びた形に変化していた．微細血管は拡張，変形し，大きさと形状が不均一となり，血管辺縁は不明瞭でありループ状の構造は観察されなかった．細胞配列パターンと微細血管構造パターンの変化によって癌とその深達度診断をすることを提唱した．同検査法は拡大内視鏡画像の理解に有用であった．

　Confocal endomicroscopy is an ultra-high magnifying endoscopy with histological observation at about 500 times magnification during ongoing endoscopy. In superficial esophageal cancerous lesions confocal endomicroscopy revealed that cellular shapes and sizes are uneven, cell concentration is increased, and cellular border is obscure. In addition the cancerous microvessels are markedly dilated and distorted, and their size and shape are uneven. The margins of microvessels are obscure, and loop formation is not usually observed. Scoring and quantification of confocal endomicroscopy might be useful for the differential diagnosis and the superficial invasive diagnosis of squamous cell carcinoma. This novel endoscopy can contribute to the understanding of magnifying endoscopy for diagnosis of superficial esophageal cancer.