病理からみた咽頭・食道表在癌の深達度診断

Histopathological Evaluation of Depth of Invasion in Superficial Esophageal and Pharyngeal Cancer

要旨●食道表在癌の深達度亜分類の変遷について概観し，肉眼型と深達度との関連について，これまでに示された症例の蓄積から0-I型と0-III型は深く，0-IIb型は浅いという共通した結論を見い出した．これらはまた中・下咽頭表在癌についても同様の傾向がみられた．T1a-EPとLPMの間の線引きはシンプルで再現性のよい基準を用いる必要があるが，食道と中・下咽頭との整合性を考慮し，実臨床に役立つものという視点も重要と考えられ，病理と臨床との間で検討がなお必要と考えられる．拡大内視鏡観察による血管パターン変化について，病理組織像との対比は技術的に困難な点も多いが，病理と臨床の協力による今後の発展が期待される．

　This paper provides an overview of the changes in subclassifications of the superficial esophageal cancer invasion depth. To date, case accumulations that have shown an association between macroscopic type and invasion depth have reached a common conclusion that stage 0-I and 0-III cancers are deep and stage 0-IIb cancers are shallow. The same trend has been seen in superficial cancer of the middle and lower pharynx. Simple criteria with good reproducibility need to be used for delineation between T1a-EP and LPM ; however, considering the consistencies between the esophagus and middle and lower pharynx, criteria that are useful in actual clinical settings are also important, suggesting the need for further examination between pathological and clinical cases. Comparing changes in vascular patterns observed by magnifying endoscopy with pathological images is technically difficult in a number of aspects. Therefore, further developments are expected through clinical and pathological cooperation.