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要旨●過去5年間に注腸X線造影検査,通常内視鏡検査,NBIおよび色素拡大内視鏡検査のすべてが施行された大腸上皮性腫瘍95例を対象とし,SM深部浸潤癌のX線造影所見,および各検査法のSM深部浸潤癌の診断能を検討した.注腸X線造影所見では,SM深部浸潤癌は腺腫,粘膜内癌,SM軽度浸潤癌に比べ表面平滑,陥凹内の不整,側面変形の頻度が有意に高かった.SM深部浸潤癌の正診率は,注腸X線造影検査78.9%,通常内視鏡検査78.9%,NBI拡大内視鏡検査89.5%,色素拡大内視鏡検査85.3%であった.また,注腸X線造影検査はSM深部浸潤癌診断の感度が最も高く,特異度が最も低かった.以上より,内視鏡検査で浸潤度診断に苦慮する大腸癌では,注腸X線造影検査は有用な検査法と考えられた.
Objective:This investigation aimed to determine the invasion depth of colorectal epithelial neoplasms using barium enema examination(BE), conventional endoscopy(CE), magnifying narrow-band imaging endoscopy(M-NBI), and magnifying chromoendoscopy(MC).
Methods:We identified 95 patients with colorectal epithelial neoplasms at our institution. The radiographic and colonoscopic findings were retrospectively investigated.
Results:The frequencies of smooth surfaces, irregularities in depression, and eccentric deformities under BE were higher in massively submucosal invasive(mSM)carcinomas as compared to those in adenomas, intramucosal carcinomas, and slightly submucosal invasive carcinomas. The accuracies of BE, CE, M-NBI, and MC findings for the diagnosis of mSM carcinomas were 78.9%, 78.9%, 89.5%, and 85.3%, respectively. The above-mentioned BE findings had the highest sensitivity, although their specificity was low.
Conclusions:We consider the combination of endoscopic and radiographic procedures to be invaluable for the determination of invasion depth of colorectal epithelial neoplasms.
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