2）内視鏡像からみた深達度診断①

Endoscopic Diagnosis of the Invasion Depth in Early Colorectal Carcinoma for the Choice of Therapeutic Strategy

要旨　内視鏡的治療を選択するための早期大腸癌深達度診断について通常内視鏡所見・拡大内視鏡所見を中心に解説した．深達度診断における拡大内視鏡によるpit pattern診断は，隆起型に比して陥凹型早期癌で有意に正診率が高かった．現在，根治的内視鏡治療の適応は浸潤先進部の組織型や脈管侵襲を考慮すると1,500μm程度のsm浸潤癌まで拡大されつつあるが，VN型pit patternをインジゴカルミン撒布所見とVN領域の面積によって細分類することによって，まず内視鏡的切除を行うべき病変，行うべきでない病変とその中間病変にふるい分けることが可能であった（有茎・亜有茎病変は除く）．高周波細径プローブによる超音波内視鏡診断はこの中間病変に対して臨床的意義があるものと考えられた．

　We assessed the invasion depth diagnosis of early colorectal carcinoma with special reference to the choice of therapeutic strategy from ordinary and magnifying colonoscopic findings. These days, some of the lesions even with submucosally massive invasion (socalled sm₂, within 1,500 μm invasion) could have been cured by complete endoscopic resection along with several other conditions. In this report, we introduced the new V type pit pattern subclassification based on the area of VN region obtained from magnifying observation of lesions. This subclassification might be useful in selecting therapeutic strategy as follows; 1) endoscopic resection as in total biopsy, 2) surgical resection, or 3) need for other detailed examinations, such as endoscopic ultrasonography using high frequency minitureprobe.