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Stomach and Intestine(Tokyo) Volume 36, Issue 11 （October 2001）

胃と腸 36巻11号（2001年10月発行）

Japanese English

今月の主題 sm massive以深に浸潤した10mm以下の大腸癌

主題

sm massive以深に浸潤した10mm以下の大腸癌のX線診断―深達度診断に有用なX線所見の解析と診断の実際 Radiologic Features of Small Invasive Early Colorectal Carcinomas 藤谷幹浩 ¹ , 斉藤裕輔 ¹ , 渡二郎 ¹ , 三好恭子 ¹ , 藤谷佳織 ¹ , 前本篤男 ¹ , 綾部時芳 ¹ , 藍田知史 ¹ , 上垣正彦 ¹ , 太田智之 ² , 折居裕 ² , 高後裕 ¹ Mikihiro Fujiya ¹ , Yusuke Saitoh ¹ , Jiro Watari ¹ , Yasuko Miyoshi ¹ , Kaori Fujiya ¹ ¹旭川医科大学第3内科 ²旭川厚生病院消化器科 ¹Third Department of Internal Medicine, Asahikawa Medical College キーワード：大腸sm癌 , X線診断 , 深達度診断 , 内視鏡診断 , 高周波超音波細径プローブ検査 Keyword: 大腸sm癌 , X線診断 , 深達度診断 , 内視鏡診断 , 高周波超音波細径プローブ検査 pp.1371-1379

発行日 2001年10月25日 Published Date 2001/10/25

DOI https://doi.org/10.11477/mf.1403103340

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要旨　10mm以下のsm深部浸潤癌のX線所見について検討した．(1)10mm以下のsm深部浸潤癌のX線描出率は100％，側面像の描出率は74％であった．(2)10mm以下の早期大腸癌の深達度診断に有用なX線所見は，側面変形，皺襞集中，陥凹型における深い陥凹や陥凹内部の凹凸であった．(3)10mm以下のsm深部浸潤癌に対するX線深達度診断能は，内視鏡，超音波細径プローブ(HFUP)と同等であった．しかし，隆起型癌や表面隆起型癌においては，sm深部浸潤癌を浅読みする傾向にあり，これらの肉眼型における深達度診断指標の確立が必要であると考えられた．

　Background and Aim: Small colorectal lesions 10 mm or less in size are often detected and most of them are easily treated by ER (endoscopic resection). However, in such small lesions, there are some invasive cancers which require surgery rather than ER. Radiologic findings that are characteristic for small invasive cancers are still unclear. The aim of this study is to elucidate the radiological features of small invasive colorectal cancers in the hope of contributing something to therapeutic strategy.

　Material and Methods: Between Jan. 1990 and May 2001, a total of 1,200 early colorectal carcinomas were detected and treated in our Hospital. Macroscopic type was divided into 804 of polypoid type (pedunculated and sessile) and 396 of Flat and Depressed type. As for the invasion depth, 847 were mucosal cancers and 353 were submucosal cancers.

　Results: 1. There were 44 small invasive cancers amongst 436 small early colorectal cancers (10.1％) . 2. Of the 44 small invasive cancers, 23 were polypoid type and 21 were F＆D type. Of the small non-invasive cancers, 285 were polypoid type and 107 were F＆D type. The incidence of F＆D type was significantly higher amongst small invasive cancers than in small non-invasive ones (p＜0.005). 3. Among the various radiologic findings reviewed, “semilunar deformity”, “converging folds toward the tumor” and “deep depression and/or irregularity of depression” appeared significantly more frequently among small invasive cancers than among non-invasive ones. At least one of these colonoscopic findings appeared in 27 (61％) of 44 small invasive cancers. However, only 9 (38％) of 24 polypoid lesion with sm-invasion revealed those findings.

　Conclusion: Small colorectal lesions with radiologic findings, such as the presence of “semilunar deformity”, “converging folds toward the tumor” and “deep depression and/or irregularity of depression” might require treatment other than ER. In polypoid cancer, it is important to establish the specific findings which reflect submucosal invasion.