臨床医の考える臨床画像と病理所見の対比—咽頭・食道

Comparisons between Clinical and Pathological Findings of Gastrointestinal Lesions Determined by Clinicians for Superficial Pharyngeal and Esophageal Carcinomas

要旨●咽頭・食道領域における癌の内視鏡像と病理組織像の対比において大切なことは，臨床医が何を知りたいかである．特に最近ではNBI拡大内視鏡を用いて狭い領域の表面微細構造や血管所見を捉えて診断することが多く，その関心領域の病理組織像を正確に描出することが求められる．そのためには，まず目的をもってきれいな画像を撮影すること，対比を行う際の指標となるメルクマールを見いだすことや関心領域を挟む2点マーキング法を活用することが重要である．そして切除した病変の適切な貼り付け，固定，画像撮影，固定後の割入れなど切除標本の的確な処理を行うこともポイントである．さらに病理医による正確なマッピングも必要不可欠である．以上のことを一つひとつ丁寧に行い，最終的に内視鏡像と固定標本マッピングとを2点マーキングを初めとしたいろいろな指標をもとに対応させ，最終的に関心領域の病理組織像を知ることで対比は完了する．

　Clinicians desire to understand the importance of contrasting endoscopic and pathologic images of carcinomas in the pharynx and esophagus. Recently, diagnosis of carcinomas has frequently been made by evaluating surface structures and vascular findings in a narrow area using narrow-band imaging magnifying endoscopy, which requires an accurate histopathological image of the region of interest. Hence, obtaining a clear and bright image and finding a marker for contrast are important ; in particular, the two-point marking method between the regions of interest is useful. Furthermore, it is essential to process the resected specimen appropriately, including prompt attachment of the resected lesion, fixation, image capture, and interdigitation after fixation. Additionally, accurate mapping by the pathologist is crucial. After carefully conducting each of the above steps, the endoscopic image and fixed specimen mapping image are compared using various indices, including two-point marking, to generate a histopathological image of the region of interest, thereby achieving the distinction.