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Stomach and Intestine(Tokyo) Volume 34, Issue 9 （August 1999）

胃と腸 34巻9号（1999年8月発行）

Japanese English

今月の主題早期胃癌のEUS診断

主題

潰瘍の有無からみた早期胃癌のEUS診断―X線・内視鏡診断学との比較を含めて Assessment of the Depth of Invasion of Gastric Carcinoma by Endoscopic Ultrasonography (EUS) Focused on Peptic Ulceration within Cancerous Areas 中村常哉 ¹ , 鈴木隆史 ¹ , 松浦昭 ¹ , 大橋計彦 ¹ Tsuneya Nakamura ¹ , Takashi Suzuki ¹ , Akira Matsuura ¹ , Kazuhiko Ohashi ¹ ¹愛知県がんセンター消化器内科部 ¹Department of Gastroenterology, Aichi Cancer Center Hospital キーワード：超音波内視鏡 , 胃癌 , 深達度 , 病巣内潰瘍 , 線維化 Keyword: 超音波内視鏡 , 胃癌 , 深達度 , 病巣内潰瘍 , 線維化 pp.1105-1117

発行日 1999年8月25日 Published Date 1999/8/25

DOI https://doi.org/10.11477/mf.1403102800

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要旨　胃癌325例に対するEUSの深達度診断正診率はm74％・sm71％・mp以深91％・全体で81％であった．早期胃癌181例の病巣内潰瘍の併存率はm癌45％・sm癌21％であった．粘膜下層から深層へ扇状に拡がる線維化巣は併存潰瘍の所見であった．この所見が明瞭に認められない併存潰瘍の線維化巣は癌浸潤に伴う線維化巣との鑑別が困難であった．EUS・X線・内視鏡の深達度診断の正診率は，部位では胃体下部～中部でEUSがX線・内視鏡を上回った．sm癌は大きさ・肉眼型によらずEUSがX線・内視鏡を上回った．潰瘍併存例ではEUSはX線・内視鏡と同様にsm₁の診断が困難であった．しかし，潰瘍非併存例ではEUSがsm₁・sm₃の診断に優れていた．

　The ability of EUS to diagnose the depth of invasion was investigated in 325 patients with gastric carcinoma, consisting of 181 early cancers and 144 advanced cancers. The depth of invasion of gastric carcinoma was classified as the mucosa (m), submucosa (sm), and muscularis propria (mp) or more advanced invasion.

　Moreover, the depth of invasion into the submucosa was divided into three subtypes (sm₁, sm₂, sm₃). Invasion of sm₁ was defined to be limited within 1 mm below the muscularis mucosae. Invasion of sm₃ was defined to be close above the muscularis propria. The depth of invasion of sm₂ was between sm₁ and sm₃.

　The results obtained were as follows; 　1) The overall diagnostic accuracy was 81％ in all 325 cases; 74％ in m cancers, 71％ in sm cancers and 91％ in mp or more advanced cancers, respectively. Rates peptic ulceration within cancerous areas were 45％ (47/104) in m cancers and 21％ (16/77) in sm cancers. The fan-like appearance of hypoechoic area in the 3rd or more deeper layer corresponded with fibrosis caused by peptic ulceration in cancerous area. It was difficult to differentiate cancerous invasion from fibrosis caused by peptic ulceration of which EUS finding had no fan-like appearance.

　2) The diagnostic accuracy of EUS was superior to those of roentgenography and endoscopy in the following cases; the cases of which the cancerous lesion was located at the lower or middle gastric body, the cases, in all size or in both protruded and excavated types of gross appearance, of which the depth of invasion was sm, and the cases without peptic ulceration in the lesion, of which the depth of invasion was either sm₁ or sm₃. However, the diagnostic accuracy of EUS was as poor as those of roentgenography and endoscopy in the cases of gastric carcinoma with peptic ulceration in cancerous area.