食道癌の生検診断について

Diagnosis of Esophageal Cancer by Esophago-fiberscopic Biopsy

　食道疾患の診療に際しての食道内視鏡検査は，食道ファイバースコープの出現により，硬式食道鏡に比すると検査手技は容易となり，患者に与える苦痛も軽減し，日常検査として胃内視鏡と同様に利用できるようになった．特に本邦では食道ファイバースコープ検査が食道疾患診断と治療効果追求のため，急速に普及しつつあるのが現状である．われわれも町田製作所製食道ファイバースコープFESを用いて食道癌の生検診断を試みたので，その成績について報告する．

　食道癌の部位，X線分類，内視鏡分類は食道疾患研究会の食道癌取扱規約によったが，内視鏡分類のうちで陥凹型については，潰瘍辺縁の立上りの明瞭な潰瘍限局型と潰瘍辺縁の不明瞭な潰瘍浸潤型とに細別した．

　During the period of January 1970 to December 1972, esophago-fiberscopic examinations were performed on 376 cases of various esophageal diseases as follows:

　108 cases of esophageal cancer (before treatment)

　38 cases of esophageal cancer (after treatment)

　1 case of malignant melanoma

　1 case esophageal metastasis of lung cancer

　1 case of esophageal metastasis of breast cancer

　227 nonmalignant cases

　Correct diagnosis by biopsy of the 108 cases of esophageal cancer (before treatment) was obtained in 99 cases (91.7%). The histological types of the 99 cases confirmed by biopsy were as follows:

　6 cases with well differentiated type of squamous cell carcinoma

　61 cases with moderately differentiated type

　31 cases with poorly differentiated type

　1 case with adenocarcinoma

　As for the rate of correct diagnosis by biopsy of esophageal cancer (before treatment), differences in longitudinal diameter and in location of lesion did not affect the ratio; but a slight decrease was seen in funnelled type of radiological classification and in stenotic type of endoscopic classification.

　After Linac and Bleomycin therapy, the rate of correct diagnosis by biopsy of esophageal cancer decreased as the amount of treatment dosage increased.

　Of 108 cases, double cancer of the esophagus and other digestive organs was noted in 6 cases.