雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Stomach and Intestine(Tokyo) Volume 49, Issue 2 （February 2014）

胃と腸 49巻2号（2014年2月発行）

Japanese English

今月の主題日本食道学会拡大内視鏡分類

主題

日本食道学会拡大内視鏡分類と深達度―鑑別・深達度診断におけるB1血管の意義 Clinical Significance of Type B1 Vessels in the Japan Esophageal Society Classification 土橋昭 ¹ , 郷田憲一 ¹ , 小林寛子 ² , 小林雅邦 ¹ , 加藤正之 ¹ , 炭山和毅 ¹ , 豊泉博史 ¹ , 加藤智弘 ¹ , 廣岡信一 ³ , 池上雅博 ³ , 田尻久雄 ^1,2 Akira Dobashi ¹ , Kenichi Goda ¹ , Hiroko Kobayashi ² , Masakuni Kobayashi ¹ , Masayuki Kato ¹ , Kazuki Sumiyama ¹ , Hirobumi Toyoizumi ¹ , Tomohiro Kato ¹ , Shinichi Hirooka ³ , Masahiro Ikegami ³ , Hisao Tajiri ^1,2 ¹東京慈恵会医科大学内視鏡科 ²東京慈恵会医科大学消化器・肝臓内科 ³東京慈恵会医科大学病理学講座 ¹Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan ²Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan ³Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan キーワード：食道表在癌 , 日本食道学会分類 , 拡大内視鏡 , NBI , 深達度診断 Keyword: 食道表在癌 , 日本食道学会分類 , 拡大内視鏡 , NBI , 深達度診断 pp.153-163

発行日 2014年2月25日 Published Date 2014/2/25

DOI https://doi.org/10.11477/mf.1403114067

PDF(4196KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside
参考文献 Reference
サイト内被引用 Cited by

要旨　食道扁平上皮癌の拡大内視鏡分類である井上分類・有馬分類を基本とし，ふたつの分類の融合・簡略化を目的として，日本食道学会分類が作成された．Type B1は扁平上皮癌の質的診断（B1以上で癌）や深達度診断（T1a-EP，LPMに相当）において，基点となる重要な血管である．Type B1の質的・深達度診断における臨床的妥当性について検討した．対象は，当科にてNBI拡大観察後，内視鏡的切除術が行われた249病変とした．Type Bの癌（質的診断）に対する感度は97.6％，陽性的中率は99.0％，Type B1のT1a-EP，LPM（深達度診断）に対する感度は91.7％，陽性的中率は88.5％であり，高い診断精度（質的・深達度診断）を有していた．日本食道学会分類Type B1に基づいた拡大内視鏡診断の臨床的有用性が示唆された．

　The classification for magnifying endoscopic diagnosis of SESCC（superficial esophageal squamous cell carcinoma）has been newly proposed by the Japan Esophageal Society. The classification was basically established based on Inoue's and Arima's classifications. The concepts of this classification are unification of Inoue's and Arima's classification and simplification of magnifying endoscopic diagnosis of SESCC. Type B1 is defined as loop-like microvessels with the four morphological changes in IPCLs（intra papillary capillary loops）, as follows, dilatation, tortuosity, caliber change in each IPCL, and variability of shapes in multiple IPCLs. Type B1 is considered a key abnormal microvessel, which is a proposed sign of SCC（squamous cell carcinoma）invasion depth of T1a-EP and T1a-LPM. We studied the diagnostic performance of Type B1 by enlisting three endoscopists for review using NBI（narrow-band imaging）magnifying endoscopic images of 249 lesions, which were all resected endoscopically. We compared the endoscopist's review results with histology from endoscopic resection. The sensitivity and PPV（positive predictive value）of Type B microvessels in the diagnosis of SESCC were 97.6％ and 99.0％, respectively. The sensitivity and PPV of Type B1 microvessel for pT1a-EP or pT1a-LPM SCC were 91.7％ and 88.5％, respectively. The diagnostic performance of Type B and B1 microvessels was sufficiently strong for SCC and T1a-EP and T1a-LPM SCC, respectively. The newly proposed the Japan esophageal society classification seems to be reliable and useful for endoscopic detection of SCC and staging of T1a-EP and T1a-LPM SCC in the esophagus.