食道SM癌の術前診断

Preoperative Diagnosis of Esophageal Submucosal Invasive Cancer

要旨●食道表在癌の治療方針を決定する際に最も問題となるのが，内視鏡的切除を適応すべきSM1以浅癌と，外科的切除や化学放射線療法を適応すべきSM2以深癌の鑑別である．当院における術前診断およびその確信度と病理組織学的結果の関係をみたところ，通常観察によるclinical（c）SM2の正診率は75%であったが，cSM2を高確信度（88%）と低確信度（63%）で診断した場合では正診率が異なっていた（p＝0.02）．同様にNBI拡大観察によるcSM2の正診率は74%であったが，cSM2を高確信度（88%）と低確信度（61%）で診断した場合では正診率が異なっていた（p＝0.03）．EUSを追加することで正診率はやや向上したが，有意ではなかった．

　The most important issue while deciding on a treatment strategy for superficial esophageal cancer is that of differentiating between superficial cancers of SM1 or higher. Endoscopic resection should be employed in cases of clinical SM1 cancer, whereas surgical resection or chemoradiotherapy should be employed in cases of SM2 cancer. The preoperative diagnosis procedure used in this hospital and an assessment of the relationship between certainty factor and tissue result showed an accuracy rate of 75% for the diagnosis of clinical SM2 cancer. This rate was different in the diagnosis of clinical SM2 cancer（high confidence：88%, low confidence：63%, p＝0.02）. The correct accuracy rate for the diagnosis of clinical SM2 by magnifying the observation was 74%. The accuracy rate of endoscopic diagnosis was different for clinical SM2 cancer（high confidence：88%, low confidence：61%, p＝0.03）. Furthermore, the accuracy rate of diagnosis was slightly improved by using an ultrasonic endoscope, but the difference was not significant.