食道扁平上皮癌の拡大内視鏡診断—基本と課題

Basic Problems of Narrow Band Imaging Magnifying Endoscopy for Superficial Esophageal Squamous Cell Carcinoma

要旨●食道扁平上皮癌における拡大内視鏡診断の最大のポイントはいかに深達度診断に寄与するかである．まずは質のよい画像を得ることが基本であり，空気量や病変のポジショニングを変化させつつ丁寧に病変を扱い，倍率を徐々に上げるなどの工夫が必要である．次にJES分類の典型的血管所見を十分理解し，感度・特異度が非常に高いB1血管以外，特にB2血管領域に着目し診断を行うべきである．しかし，B2血管にはvariationが多いことが課題であるが，最近，提唱されたB2i血管やpT1b-SM2癌の所見としての隆起型＋B2血管，B2血管の領域性が有用である可能性があり，今後のさらなる検討が必要である．

　There is a maximum point of narrow band imaging magnifying endoscopic diagnosis for superficial esophageal squamous cell carcinoma that contributes to invasion depth. The first basic requirement is to obtain good quality endoscopic images. To achieve this, it is advisable to carefully observe the lesion while changing the quantity of intraesophageal air and positioning of the lesion, as well as the ability to gradually enlarge the magnification is necessary. Next, the typical vessel pattern of the Japan Esophageal Society classification should be well-understood, and attention should be paid to Type B2 microvessel domains in addition to Type B1 microvessels.

　However, there is a problem that Type B2 microvessels show much variation, but we proposed that the correlation between protruding lesions and Type B2 microvessels or their domain characteristics and pT1b-SM2 cancer may be useful. Furthermore, further future research is necessary.