進行胃癌のX線診断体系update

Update of X-ray Diagnosis System for Advanced Gastric Cancer

要旨●かつて国民病と言われた胃癌に対し，胃X線検査は検診として死亡率減少効果を示し，診断学を発展させた．近年，画像強調内視鏡を用いた拡大内視鏡診断が発展し，粘膜表層の微細構造から胃癌を正確に診断することが可能となった．しかし胃癌には，粘膜層に存在せず，粘膜下層以深を浸潤する病変が少なからず存在する．胃X線検査では，粘膜下腫瘍様隆起，粘膜ひだ所見，変形などの所見から，粘膜下層以深の胃癌の浸潤範囲を診断することが可能であり，撮影前に描出すべき所見を熟考し，撮影手順を検討することが重要である．内視鏡検査と胃X線検査を組み合わせ，それぞれの長所を生かすことにより，正確な診断から適切な治療を選択することができる．

　Gastric X-ray examination has demonstrated a mortality-reducing effect as a screening method for gastric cancer, which is often referred to as a national disease, and has advanced diagnostic science. In recent years, the development of magnifying endoscopic diagnosis with image-enhanced endoscopy has enabled accurate diagnosis of gastric cancer based on the microstructure of the mucosal surface layer. However, a significant number of gastric cancers do not remain confined to the mucosal layer but invade the submucosa and deeper layers. Gastric X-ray examination can assess the extent of gastric cancer invasion beyond the submucosal layer by identifying findings such as submucosal tumor-like protuberances, mucosal folds, and deformities. Therefore, it is crucial to carefully consider the findings to be depicted and the imaging procedure prior to the examination. An appropriate treatment is selected based on an accurate diagnosis by combining endoscopy and gastric X-ray examination and using the strengths of each.