7) 拡大内視鏡による癌の深達度診断

Usefulness of Magnification Endoscopy in the Determination of the Depth of Invasion of Gastric Cancer

要旨　近年，通常観察用スコープと同等の操作性・CCD を有する拡大電子内視鏡が開発され，上部消化管領域でも拡大内視鏡が普及しつつある．拡大内視鏡の胃癌に対する質的診断，境界診断の有用性は多数報告されているが，深達度診断に関してはいまだ一定の見解は得られていない．そこで今回，胃癌の拡大内視鏡所見と深達度の関係を組織型別に検討した．分化型癌の場合，小さな顆粒構造を示すsmall regular patternではM癌が多く，構造が破壊されたlack of visible structureではSM癌が多かった．また微小血管所見では，拡張した不整な血管像がみられた場合はSM癌が多かった．これらの組み合わせにより，深達度診断の一助となる可能性が示唆された．

　Magnification endoscopes that come up to the level of conventional endoscopes in handling ease have been developed in recent years, and magnification endoscopy has become widely used in the upper gastrointestinal tract. The usefulness of magnification endoscopy has often been reported in the diagnosis of gastric cancer and in the determination of its extent, but with regard to the determination of its depth of invasion, the usefulness is controversial. We investigated the relationship between the magnification findings and depth of invasion. We often observed intramucosal cancer with small regular pattern and submucosal cancer with lack of visible structure in differentiated carcinoma, and carcinomas with dilated vessels often invasive to the submucosal layer. This indicates that magnification endoscopy may help determine the depth of invasion of gastric cancer.