内視鏡治療後サーベイランスに関わる病理組織学的診断の問題点

Some Issues of Histopathological Diagnosis in the Surveillance after Endoscopic Treatment of Gastrointestinal Epithelial Neoplasms

要旨●消化管粘膜に生じた腫瘍あるいは腫瘍類似病変の内視鏡的切除検体の病理組織学的検索とともに，その後のサーベイランスの過程においても生検や追加切除検体の病理組織学的検索は必須・重要である．それらに関連した問題点としては，切除断端評価に関する精度・方法の限界，再発病変と新規発生病変の鑑別をめぐる困難，背景粘膜の状態が生検や追加切除検体の病理組織学的診断に影響する場合，といったことが考えられる．これらの点を内視鏡医も認識しておく必要があるとともに，日常的に担当病理医と議論し，双方でコンセンサスを得る努力が必要と思われる．

　During post-endoscopic treatment of gastrointestinal epithelial neoplasms, histopathological diagnosis of biopsy and/or additional endoscopic resection material is mandatory and crucial as well as that of the main neoplasm. The problems concerning histopathological diagnosis in the surveillance process include the limitation of the accuracy and technique in the assessment of resection margins, some challenges in differential diagnosis between recurrent neoplasms and neoplasms developing de novo, and the status of the background mucosa influencing the interpretation of histopathological diagnosis of biopsy and/or additional treatment material. These factors should be understood by endoscopists, and should also be discussed with pathologists trying to achieve a consensus in daily practice.