1）二重造影像からみた深達度診断

Diagnosis of Depth of Superficial Cancer of the Esophagus: Cancerous Depth Diagnosis in Terms of Double Contrast Radiography

要旨　二重造影像を用いて，食道表在癌の治療法の決定に対応しうる亜分類レベルの深達度診断法を検討した．正面像では，隆起型病変は隆起の高さが2mmを超えているか否か，隆起の立ちヒがり方，隆起周囲の随伴病変の有無が特に重要であり，陥凹性病変は陥凹部の陰影斑の濃さ，陥凹内の粘膜不整の程度，陥凹内隆起成分の数と大きさが有力な診断指標となりえた．側面像では，隆起型も陥凹型もともに，無変形型，単純直線型，不整直線型，平皿状陥凹型，楔状陥凹型，台形状陥凹型，椀状陥凹型の7型に分類された変形パターンが深達度をよく反映した．X線診断は正面像の各所見と側面変形の各パターンを適宜組み合わせて進めることが重要であり，それによって治療法の決定に対応しうる精細な深達度診断法が可能になることを述べた．

　To make a detailed study of cancerous depth in order to decide the most fitting treatment, double contrast radiography was employed for guaging the depth of invasion of superficial cancer of the esophagus. In implementing the diagnostic procedures, the profile view plays a major role, though, not infrequently, it needs to be supplemented with a front view. Pertaining to the front view, in case of an elevated lesion, whether or not the height of the elevation exceeds 2 mm, how the lesion rises from the neighbouring surface, and whether or not any concomitant lesion is present in the vicinty of the elevation are of primary importance. On the other hand, in case of a depressed lesion, degrees of thickness of barium fleck inside the depressed area, degrees of unevenness (concaved or convexed), and the number and size of elevated components consisting mainly of granules and/or nodules were concluded to be fairly reliable indicators of the cancerous depth. Pertaining to the profile view, seven deformity patterns which we have currently deserved are as follows. A: no deformity, B1: straightened, B2: jaggy-straightened, C: saucer-shaped, D: wedge shaped, E: barge-shaped, F: bowl-shaped. The classification of these seven deformity patterns, applied to both elevated and depressed lesions, are indicative of the cancerous depth. Accordingly, x-ray diagnostic procedures are best implemented by adequately combining the findings of both the profile view and the front view. Such an approach, enables us to establish a much more precise depth diagnosis of superficial cancer of the esophagus and helps to indicate the most suitable treatment.