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Stomach and Intestine(Tokyo) Volume 50, Issue 3 （March 2015）

胃と腸 50巻3号（2015年3月発行）

Japanese English

今月の主題胃癌範囲診断における拡大観察のピットフォール

主題研究

背景胃粘膜からみた境界診断が難しい分化型癌の特徴 Characteristics of The Background Gastric Mucosa Surrounding Differentiated-Type Gastric Cancer with Unclear Margins 川村昌司 ¹ , 関根仁 ¹ , 菊地達也 ¹ , 境吉孝 ¹ , 長㟢太 ¹ , 長沼廣 ² , 渋谷里絵 ² Masashi Kawamura ¹ , Hitoshi Sekine ¹ , Tatsuya Kikuchi ¹ , Yoshitaka Sakai ¹ , Futoshi Nagasaki ¹ , Hiroshi Naganuma ² , Rie Shibuya ² ¹仙台市立病院消化器内科 ²仙台市立病院病理診断科 ¹Department of Gastroenterology, Sendai City Hospital, Sendai, Japan ²Department of Pathology, Sendai City Hospital, Sendai, Japan キーワード： NBI , 拡大内視鏡 , 胃癌 , Helicobacter pylori Keyword: NBI , 拡大内視鏡 , 胃癌 , Helicobacter pylori pp.311-319

発行日 2015年3月25日 Published Date 2015/3/25

DOI https://doi.org/10.11477/mf.1403200170

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要旨●当院にてESDを行った分化型早期胃癌（未分化混在型を除く）140病変のNBI拡大内視鏡像について周囲粘膜を含め検討した．NBI拡大像はPM（pit/mesh）型（円形〜縦長の腺開口部と網目状血管）・GL（groove/loop）型（溝状に連続した腺開口部とループ状血管）に分類し，癌周囲にはGL型主体（単独・優勢混在）の粘膜が多くみられた〔114例（81.4％）〕．NBI拡大観察による範囲診断困難な症例は14例あり，病変・周囲粘膜でGL型主体の近似したNBI像を認める例が多く〔10例（71.4％）〕，低異型度高分化型・横這い型中分化型癌が多くみられた．周囲粘膜にはlight blue crestが高率にみられ〔110例（78.6％）〕，境界診断に有用な例もみられた．NBI拡大観察による分化型癌の範囲診断は，その背景粘膜を含めた病理組織像の特徴を理解して行う必要がある．

　In this study, we investigated 140 lesions of differentiated-type early gastric cancer after endoscopic submucosal dissection and identified the characteristics of the cancerous and non-cancerous areas surrounding the gastric cancer using magnifying narrow band imaging（NBI）endoscopy. We classified NBI images into two patterns, including the pit/mesh（PM）pattern, where crypt openings are represented by round or dilated pits, and microvessels are seen as mesh structures, and the groove/loop（GL）pattern, where crypt openings are represented by groove structures, and micovessels are exhibiting coiled or looped structures.

　By magnifying NBI endoscopy of the background mucosa surrounding the differentiated-type cancer lesions, a higher frequency of the GL-dominated pattern［114/140（81.4%）］was observed. The diagnostic accuracy of NBI in terms of identifying the extent of the tumor was 90.0%（126/140）; however, in 14 cases（10.0%）it was difficult to diagnose the extent of the tumor. We investigated the characteristics of the cancer lesions with unclear margins, and discovered that GL-dominated patterns were frequently observed both in the cancer and in the background area［10/14（71.4%）］. In 110/140（78.6%）cases, the light blue crest sign was observed by magnifying NBI endoscopy in the background mucosa surrounding the differentiated-type gastric cancers.

　Magnifying NBI endoscopy appeared useful for diagnosis of the lateral extent of gastric cancer; however, careful observation of the background mucosa surrounding the cancer is required.