咽頭拡大内視鏡診断の基本と最新知見

The Most Effective Approach to Use the Magnified Endoscopy for Detecting Superficial Pharyngeal Cancer

要旨●咽頭表在癌を発見し低侵襲の内視鏡治療を行えることは，臓器機能の温存やQOLの観点から意義深い．このためには拡大内視鏡診断が欠かせない．拾い上げは非拡大観察での色調の変化などをもとに行い，引き続いて拡大観察で確信を得る．鑑別すべき疾患にリンパ濾胞や乳頭腫，異型上皮などがあるが，血管像をよく観察することで概ね鑑別可能である．拡大内視鏡診断は日本食道学会分類を用いて行われているが，深達度診断において有用かどうかはこれからの課題である．観察時の出血を来さない工夫，弱拡大〜中拡大での観察などを心がけることで，診断の精度が向上するものと考えられる．

　Detection of superficial pharyngeal cancer and endoscopic removal are important to maintain organ function and quality of life. Therefore, magnified endoscopy is essential. First, the lesion is screened by non-magnified endoscopy, following which it is examined by magnified endoscopy. By this approach, we found that determining a differential diagnosis between lymphoid follicle, papilloma, dysplasia, and carcinoma by carefully observing the microvessels was not difficult. Further studies are needed to investigate whether magnifying endoscopic classification of the Japan Esophageal Society is beneficial in making a diagnosis of pharyngeal cancer depth in the future. A more precise diagnosis is obtained when the lesion is carefully observed from low to middle power field.