画像所見と病理所見の対比法のコツ：食道─関心領域における2点マーキング法

Technique for Comparing Endoscopic Images with Macroscopy and Histopathology Findings in Superficial Esophageal Carcinomas：the Two Point Marking Method

要旨●画像所見と病理所見を正確に対比するコツの第一歩は，魂のある画像を撮影することである．食道表在癌では深達度がリンパ節転移と強く相関するため，深達度診断の根拠となるきれいな画像を記録しなければならない．切除後は標本を適切に伸展させ，関心領域を中心に割を入れ，割入りの固定標本を撮影後，病理医に提出する．次に病理診断，割入り固定標本上のマッピングをもとに内視鏡像との対比を行う．対比の際には，ヨード不染帯辺縁形状や扁平上皮島とともに，関心領域における2点マーキング法が有用である．最後に自らの診断にフィードバックできた時点で，正確な対比は完了する．

　It is very important to record a sharp endoscopic image to allow a comparison of endoscopy with a histopathological diagnosis. A clear endoscopic image allows accurate assessment of the tumor invasion depth, which strongly correlates with the rate of lymph node metastasis in esophageal carcinomas. After performing an endoscopic resection, the immediate and appropriate extension of the resected specimens is the next priority. The sectioning lines should be positioned for the targeted regions, with two points used as markers. After photographing a stereomicroscopic image of the formalin-fixed resected specimen, the specimen should be submitted to the pathologist for a histological diagnosis. Finally, a comparison between the endoscopic image and histological mapping of the tumor can be accomplished. To achieve a precise comparison, the lateral shape of the area unstained with iodine and the squamous island may be very helpful as two points marking the targeted region. However, the most important benefit is the improvement in precision of the endoscopic diagnosis itself.