内視鏡像と病理組織像の対比方法の双璧—KOTO MethodとKOTO Method II

KOTO Method and KOTO Method II：The Two Best Methods for Achieving Complete One-to-One Correspondence between Endoscopic and Histopathological Images

要旨●内視鏡像と病理組織像を正確無比に対比する2つの方法，KOTO methodとKOTO method IIを紹介する．前者は，検体の固定と撮像，検体画像と病理組織像の重ね合わせ，検体画像と内視鏡像の対応および内視鏡像と病理組織像の重ね合わせ，の3段階で行う方法で，腺管レベルで詳細に対比できる．後者は，薄切後のパラフィンブロックを融解させて粘膜の表面と断面を撮像し，切り出し時の検体画像や内視鏡像と対比して，粘膜表面の薄切箇所と病理組織像を重ね合わせる3次元的な観察方法で，細胞レベルで詳細に対比できる．この2法は少し手間がかかり，後者は病理スタッフの協力を要するが，費用はほぼ不要で，内視鏡像の理解をかなり深めることができる．

　We describe two methods, KOTO Method and KOTO Method II, which allow detailed endoscopic result adjustment to match histopathological findings. The KOTO Method comprises three steps：first, adjusting the picture of the whole specimen, which attached flat on a board and fixed by buffered formalin followed by cutting mucosa, to the histopathological image, second, superimposing a magnified histopathological image on a specimen picture with the area of interest, and the last, comparing the magnified picture of the specimen to the endoscopic image to establish correspondence between the endoscopic image and the histopathological image, showing correspondence of a white zone and epithelium of a glandular edge. The KOTO Method II is implemented by taking a picture of the mucosal surface and cross-section of the dewaxed specimen after thin sectioning for hematoxylin and eosin（H&E）stain and adjusting the point of thin sectioning on the mucosal surface and H&E image by comparing the picture of the dewaxed specimen to a picture of the endoscopic submucosal dissection specimen, resulting in correspondence of endoscopic and histopathological features at cellular level with three-dimensional visualization. These two methods are time-consuming and require cooperation from the pathology team staff but are cost effective and extremely useful for understanding endoscopic images.