微小胃癌診断のコツ―肉眼所見と対比して―内視鏡の立場から

Diagnosis of Minute Cancer Viewed from a Endoscopic Standpoint

要旨　5mm以下の微小胃癌の診断は癌の周りの反応性変化による盛り上がり（周堤）の有無によってかなり異なる．特に4mm以下のものでは周堤のないものは発見しにくい．分化型癌のほうが未分化癌より周堤（＋）のものが多く発見しやすい．未分化癌の中でも胃底腺領域の微小m癌は診断が難しい．内視鏡によるpickupの限界は3mm，その極限は2mmと考えられる．

　Ninety-four lesions of minute cancer (defined as those less than 5 mm) were analysed pertaining to endoscopic features.

　1. Difficulty in diagnosing minute cancers depends on whether or not there is any surrounding elevation caused by the reactive proliferation to cancer itself.

　Especially in case of cancers less than 4 mm showing no surrounding elevation, detection becomes extremely difficult.

　2. Well differentiated cancers were more likely to show the surrounding elevation than poorly differentiated cancers, making the detection of the former much easier.

　Detection of poorly differentiated mucosal cancer in the fundic gland region is also very difficult.

　3. Endoscopic limitation in spotting the lesions can be concluded as 3 mm in diameter. Upon close scrutiny in detailed examination 2 mm.