手つなぎ・横這い型胃癌

Range Diagnosis of “Crawling-type” Adenocarcinoma of the Stomach

要旨●2012年1月〜2018年4月までに当院で内視鏡的粘膜下層剝離術（ESD）もしくは外科手術をされ，切除検体で手つなぎ・横這い型胃癌と診断された早期胃癌44病変に対して範囲生検の陽性・陰性的中率および術後のマッピング像を後ろ向きに検討し，範囲診断能を検討した．白色光像，インジゴカルミン撒布像，NBI拡大像で範囲明瞭と判断できたものはそれぞれ38.6%（17/44），56.8%（25/44），68.2%（15/22）であった．術前の範囲生検において陽性，陰性の正診率は95.5%（84/88），85.9%（263/306）であった．切除検体のマッピング像をもとに腫瘍の拡がりを検討したところ，類円型24病変に対して不整型は20病変と，類円型である病変が多かったが，約半数ほど不整な伸展を呈していた．術前に範囲を正確に認識できていた症例も認められたが，当初の認識と異なっていた症例が数例見受けられ，手つなぎ・横這い型胃癌に対して生検による範囲診断は重要と考えられた．

　We retrospectively studied the positive and negative predictive values of range biopsy and postoperative mapping in 44 patients with early gastric cancer who had undergone endoscopic submucosal dissection or surgery at our hospital between January 2012 and April 2018 and were initially diagnosed with “crawling-type” adenocarcinoma of the stomach on the basis of histopathological findings in resected specimens.

　Following the distribution of white light image and indigo carmine dine, 38.6%（17/44）, 56.8%（25/44）, and 68.2%（15/22）, respectively, were judged to be clear by NBI（narrow band imaging）magnifying classifications. The accuracy of positive and negative NBIs were 95.5%（84/88）and 56.8%（263/306）, respectively, whereas the positive and negative accuracy rates in the preoperative range biopsy were 95.5%（84/88）and 85.9%（263/306）, respectively. Furthermore, on examining the extent of the tumor on the basis of the mapping image of the resected specimen, 20 lesions were found to be of irregular type and 24 of circular type.

　In some cases, the range of gastric crawling-type adenocarcinoma could be recognized accurately prior to surgery. However, in some cases, this value differed from that recognized initially by a certain number. Therefore, range diagnosis using biopsy can be considered an important diagnostic method.