2）内視鏡像からみた深達度診断

Endoscopic diagnosis of the Depth of Cancer Invasion for Gastric Cancer

要旨　胃癌の内視鏡的な深達度診断の精度は著しく向上したが，いまだ十分とは言い難い．胃癌の内視鏡深達度診断について概説した．隆起型では一般的に進行癌は少ないが，壁の硬化像や粘膜下膨隆像，表面のびらん像などがsm以深の癌を疑う根拠となる．陥凹型早期胃癌の基本形はⅡcであり，潰瘍性変化を伴う場合と，伴わない場合の二者に分けて考える．深達度指標として，①陥凹面の色調，②ひだの所見，③壁の厚み・硬化像，④陥凹面の構造，⑤辺縁の隆起・膨隆像，⑥病変の大きさ，が挙げられる．現時点での筆者らのprospectiveな診断精度について評価を加えたところ，sm癌を正しくsm癌と診断できたものは66％にすぎず，特に不良であった．直感的な診断のみに頼らず，診断可能な指標を正しく再確認しながら着実に診断を進める態度が不可欠である．

　The accuracy of endoscopic diagnosis of the depth of cancer invasion for gastric cancer has been improving, but it is still not satisfactory. I described a guide for diagnosis of invasion depth according to various type of gastric cancers. There are not many advanced cancers among the elevated type of gastric cancer. Stiffness of a gastric wall, SMT-like appearance and erosive change of the surface are useful as indicators of deeper invasion. As for IIc type of gastric cancer, abnormal findings of surface color, converging folds, stiffness of the wall, structure of the depressed surface and size are useful for diagnosis of the invasion depth. Naturally, it is impossible to diagnose perfectly and faultlessly, but we should exert ourself to the utmost to make careful examinations and use a reliable index for judgements about invasion by various types of cancers.