悪性腫瘍症例におけるヨード染色法の有用性

Endoscopic Iodine Staining Test for Early Detection of Esophageal Cancer for Patients with Malignant Lesions and After Treatment

要旨　悪性腫瘍を有する症例，あるいは悪性腫瘍に対する治療を受けた症例における，食道癌のヨード染色併用内視鏡的スクリーニングを試みた．既に食道癌の判明したものや，食道症状を有するものは除いた．203症例（頭頸部癌45例，食道癌50例，胃癌79例，結腸直腸癌17例，および原発不明癌12例）の54％にヨード不染帯を，また食道癌を6.9％に認めた．発見食道癌は，すべて0-Ⅱ型を示し，深達度はm1（13例），m2（1例）であった．全例に対して，内視鏡的粘膜切除法による治療が適応となった．不染帯および食道癌の発見頻度は，従来の報告と比較して明らかに高率であった．この結果は，悪性腫瘍症例に対する内視鏡的食道癌スクリーニングの有効性を示すものと考えられた．

　Endoscopic screening for esophageal cancer aided by iodine staining technique was carried out on patients with any malignant diseases before treatment or after treatment. Incidence of esophageal cancer and efficacy of endoscopic iodine staining technique were discussed. Two hundred and three patients were included in this study (head and neck cancer 45 cases, esophageal cancer 50, gastric cancer 79, colorectal cancer 17 and others 12). They occupied 1.5% (203/13,000 cases) of all patients who underwent upper gastrointestinal endoscopy in the same period of 1991 and 1992. Cases with known esophageal cancer and those with esophageal complaints suggesting esophageal abnormalities were excluded from this study. Incidence of unstained area and carcinoma were analyzed: In cases with head and neck cancer, unstained area was noticed in 47% of patients and cancer was found in 6.7%; esophageal cancer, 68% and 16%; gastric cancer, 44% and 2.5%; colorectal cancer, 41% and 0%; those with cancer of unknown origin, 17% and 8.3%. Incidence of unstained area was 54% of all cases, of cancer 6.9% and of dysplasia 1.5%. Endoscopic findings and pathological study revealed that all esophageal cancers detected in this study were 0-Ⅱ type, and the depth of cancer invasion remained within the lamina propria mucosae. All esophageal cancer lesions could be removed by endoscopic mucosal resection technique. In this study, incidence of unstained area and esophageal cancer was remarkably higher than that reported previously (0.014～0.66%).

　Results of this study suggest that endoscopic screening for esophageal cancer aided by iodine staining technique among patients with malignant lesions or history of malignancy was effective.