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Stomach and Intestine(Tokyo) Volume 49, Issue 13 （December 2014）

胃と腸 49巻13号（2014年12月発行）

Japanese English

今月の主題胃の腺腫─診断と治療方針

主題

胃扁平隆起型腺腫と0-IIa型病変の鑑別診断における非熟練者に対する狭帯域光観察併用拡大内視鏡の有用性と問題点 Usefulness and Limitations of the Magnifying Endoscopy with Narrow-band Imaging for the Differential Diagnosis of Flat Elevated Adenoma and 0-IIa in the Non-expert Endoscopist 長浜孝 ¹ , 小島俊樹 ² , 八尾建史 ² , 藤原昌子 ² , 久部高司 ¹ , 高木靖寛 ¹ , 平井郁仁 ¹ , 松井敏幸 ¹ , 今村健太郎 ³ , 田邊寛 ³ , 岩下明德 ³ , 金坂卓 ⁴ Takashi Nagahama ¹ , Toshiki Kojima ² , Kenshi Yao ² , Syoko Fujiwara ² , Takashi Hisabe ¹ , Yasuhiro Takaki ¹ , Fumihito Hirai ¹ , Toshiyuki Matsui ¹ , Kentaro Imamura ³ , Hiroshi Tanabe ³ , Akinori Iwashita ³ , Takashi Kanesaka ⁴ ¹福岡大学筑紫病院消化器内科 ²福岡大学筑紫病院内視鏡部 ³福岡大学筑紫病院病理部 ⁴大阪府立成人病センター消化管内科 ¹Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan ²Department of Endoscopy, Fukuoka University Chikushi Hospital, Chikushino, Japan ³Department of Pathology, Fukuoka University Chikushi Hospital, Chikushino, Japan ⁴Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan キーワード： 0-IIa , 胃腺腫 , NBI併用拡大内視鏡 , VS classification system , VS discordance , VEC pattern , vessels within epithelial circle pattern , dense-type crypt opening Keyword: 0-IIa , 胃腺腫 , NBI併用拡大内視鏡 , VS classification system , VS discordance , VEC pattern , vessels within epithelial circle pattern , dense-type crypt opening pp.1815-1826

発行日 2014年12月25日 Published Date 2014/12/25

DOI https://doi.org/10.11477/mf.1403200106

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要旨　目的：表面隆起型上皮性腫瘍について腺腫と癌の鑑別診断における狭帯域光観察併用拡大内視鏡（M-NBI）の有用性と問題点を検討した．対象と方法：表面隆起型上皮性腫瘍147病変（軽度〜中等度異型腺腫（LGA）群48病変，胃癌・高度異型腺腫（EC）群99病変）を対象に組み入れた．熟練者，非熟練者による通常内視鏡（C-WLI）とM-NBIの診断能を求めた．成績：熟練者と非熟練者によるVS classification systemを用いたM-NBIの診断能は，両者とも，感度，正診率がC-WLIより高かった．しかし，非熟練者においては，特異度（84.8％ vs 70.8％）がC-WLIより低い傾向を示し，特に低確信度群においては37.5％と極端に特異度が低かった．M-NBI低確信度群にVS discordance，vessels within epithelial circle pattern（VEC pattern），dense-type crypt opening（dense-CO）を加えると特に特異度の向上を認めた．結語：VSCSを用いたM-NBIは熟練者・非熟練者においてもC-WLIと比較して癌と腺腫の鑑別診断に有用であった．VS discordance，VEC pattern，dense-COは非熟練者の特異度の向上に有用であった．

　Purpose : The effectiveness of and problems related to using magnification endoscopy combined with narrow-band imaging laparoscopy（M-NBI）in the differential diagnosis adenoma and carcinoma, in a case of surface-grown type epithelial carcinoma were studied.

　Subjects and methods : The 147 lesions of surface-grown type epithelial carcinoma［light to medium degree atypical tumor（LGA）group, 48 lesions ; gastric cancer and high degree atypical tumor（EC）group, 99 lesions］were included in the study. Skilled and unskilled practitioners determined the diagnostic performance of common-white light imaging（C-WLI）and M-NBI for comparison.

　Results : The diagnostic performance score determined by both, the skilled and unskilled practitioners, was high in sensitivity for M-NBI using the VS classification system（VSCS）, as compared with that for C-WLI. However, the unskilled practitioners determined low specificity for M-NBI（84.8％ vs 70.8％）, particularly in the low certainty factor group. The score for specificity was as low as 37.5％, which was lower than that for C-WLI. On adding VS discordance, vessels within epithelial circle pattern（VEC pattern）, and dense-type crypt opening（dense-CO）to the M-NBI low certainty factor group, we observed that the practitioners' score of specificity improved.

　Conclusion : M-NBI using the VSCS is effective for skilled as well as unskilled practitioner in the differential diagnosis of adenoma and carcinoma, as compared with that by C-WLI. In addition, VS discordance, VEC pattern and dense-CO were effective for unskilled practitioners to improve their specificity score.