咽喉頭表在癌の内視鏡的診断—経口内視鏡の立場から

Endoscopic Diagnosis of Superficial Pharyngolaryngeal Carcinoma Using Transoral Endoscopy

要旨●咽喉頭表在癌は腫瘍の厚みとリンパ節転移が相関することが報告されており，内視鏡診断において深達度診断を行うことは重要なポイントである．当院でESDを行った咽喉頭表在癌57病変の内視鏡所見と病理組織学的所見を詳細に検討し，肉眼型・JES-SCC分類に関して0-IIb型・0-IIa型あるいはType A・B1血管の場合EPあるいはSEP浸潤（<1,000μm），0-Is型あるいはType B2・B3血管の場合SEP浸潤（≧1,000μm）が有意に多い結果であった．また肉眼型→隆起型表面性状→JES-SCC分類をもとにしたフローチャート式での深達度評価より，①0-IIb型では深達度はEPあるいはSEP浸潤（<1,000μm），②0-Is型では深達度はSEP浸潤（≧1,000μm），③0-IIa型では顆粒状＋Type B1血管であれば深達度はEPあるいはSEP浸潤（<1,000μm），平滑であればSEP浸潤（≧1,000μm）と診断することが妥当と考えられた．

　Studies have reported that tumor thickness correlate with lymph node metastasis in superficial carcinoma of the pharyngolarynx and that the invasion depth of the tumor must be diagnosed by endoscopy. We comprehensively reviewed the endoscopic and histopathological findings of 57 superficial oropharyngeal cancers that were subjected to endoscopic submucosal dissection in our hospital and identified the following lesion types：types 0-IIb ; types 0-IIa or A or B1 vessels in terms of gross type and Japan Esophageal Society squamous cell carcinoma（JES-SCC）classification, EP（epithelium）or SEP（subepithelial layer）invasion（<1,000μm） ; type 0-Is or B2 or B3 vessels with SEP（≥1,000μm）in the case of types 0-Is or B2/B3 vessels. The flowchart evaluation based on the gross type → raised surface → JES-SCC classification showed that（1）types 0-IIb had EP or SEP involvement（<1,000μm）,（2）types 0-Is had SEP involvement（≥1,000μm）,（3）types 0-IIa had granular ＋ B1 vessels（≥1,000μm）,（4）types 0-IIb had EP or SEP involvement（<1,000μm）, and （5）types 0-IIb had SEP involvement（<1,000μm）. The diagnosis of EP or SEP involvement（<1,000μm）for type 0-Is and SEP involvement（≥1,000μm）for type 0-IIa was considered reasonable if the vessel was smooth.