消化管粘膜下腫瘍のEUS診断—EUS-FNAを含めて

Gastrointestinal Submucosal Tumor Diagnosis:EUS and EUS-FNA

要旨●粘膜下腫瘍（SMT）は，上下部内視鏡検査において偶然発見されることが多く，その内容は多岐にわたる．SMTの診断は，通常の内視鏡下観察および生検では困難であることが多い．SMTに対するEUSでは病変の主座やエコーレベルに留意して観察を行うことが重要である．EUS-FNAは，超音波内視鏡ガイド下に腫瘍を確実に穿刺できる安全かつ正確な組織検査法であり，SMTの組織診断において有用な検査法である．20mm以下であっても，第3層以深の低エコーを呈する充実性腫瘍はEUS-FNAの適応となる．

　Gastrointestinal submucosal tumors（SMT）, including both benign and malignant lesions, are often incidentally detected during gastrointestinal endoscopy. SMTs are often difficult to diagnose using conventional endoscopic images and forceps biopsies. It is important to observe the tumor location and echo findings in the EUS layer structure. EUS-FNA is a safe and accurate histological examination for SMTs, which has undergone technical and equipment advances, allowing the tumor to be reliably punctured. EUS-FNA examination is requested when the SMT is solid and/or is suspected to the origin of the fourth layer, even for tumors of <20mm.