食道表在癌のX線学的深達度診断の精度―X線所見と切除標本・病理所見との対比

Differential Diagnosis between Intraepithelial Carcinoma and Mucosal Carcinoma Based on Radiological Estimate of the Depth of Cancer Invasion: Comparison between Radiographic and Pathological Findings of Esophageal Cancer

要旨　食道表在癌のX線学的深達度診断の精度を検討するため，自験33例41病変におけるX線所見と切除標本・病理所見との対比を行った．最初に，診断の基礎となるべき病理学的事項として肉眼型分類を行い，大きさ・周在率の分布を検討した．その結果，特に0-Ⅱc型におけるep，mm癌の深達度診断が重要であることがわかった．ep癌の切除標本肉眼所見は，点と溝であった．肉眼病変境界診断域よりヨード不染域のほうが広範囲であった．X線像は，空気少量の二重造影像で点，溝として描出できたが，空気中等量の二重造影像では，境界不鮮明な淡いバリウム斑として描出された．mm癌の切除標本肉眼所見は，深溝と面であった．肉眼病変境界診断域とヨード不染域はよく一致した．X線像は，niveau差の認められる境界鮮明なバリウムの溜まり（面状陥凹）として描出された．

　In the last eightyears, nine cases of intraepithelial carcinoma (ep-ca), twelve cases of mucosal carcinoma (mm-ca) and twelve cases of submucosal carcinoma (sm-ca) of the esophagus were detected and resected in our hospital.

　Ep-ca and mm-ca were classified macroscopically into three basic types corresponding to those of early gastric cancer (type Ⅱa, Ⅱb, and Ⅱc) and sm-ca into four types (type Ⅰ, Ⅱc, mixed and semiadvanced).

　On the other hand, invasion was found in the submucosa for the lesions of 2 to 10 cm in size, in the mucosa for those smaller than 6 cm and in the intraepithelium for those smaller than 3cm.

　Thus, it is necessary for us to radiologically estimate the depth of cancer invasion in the differential diagnosis between ep-ca and mm-ca.

　In radiological study, granularity and irregular grooves were related to the presence of ep-ca, whereas deep irregular grooves and irregular surface depression were associated with mm-ca.