| 特集名 | 早期消化管癌に対するEMR -- 適応拡大をめぐる問題 | |
|---|---|---|
| 題名 | 早期胃癌に対するEMR (3) 胃腫瘍性病変のEMRの適応 -- 内視鏡所見・生検診断の再検討 | |
| 発刊年月 | 2001年 11月 | |
| 著者 | 道田 知樹 | 国立大阪病院消化器科 |
| 著者 | 西村 善也 | 国立大阪病院消化器科 |
| 著者 | 池田 昌弘 | 国立大阪病院消化器科 |
| 著者 | 辻仲 利政 | 国立大阪病院外科 |
| 著者 | 河原 邦光 | 国立大阪病院臨床検査科 |
| 著者 | 倉田 明彦 | 国立大阪病院臨床検査科 |
| 【 要旨 】 | 内視鏡治療の対象となりうる胃腫瘍において，内視鏡診断の正確性を評価した． 1)早期癌手術例では，深達度正診率はm癌81％，sm癌60％で，生検診断正診率は79％であった． 2)生検GroupIII病変EMR例では，23％は術後診断が早期癌で，これらの腫瘍径は腺腫群より有意に大きかった．形状ではI・IIc型で，異型度では高異型度群で，癌と診断されやすかった．女性では腺腫成分を伴わない癌が多かった． 3)早期癌EMR例108例では，10例(9％)にEMR前後の診断相違(6例がsm癌，7例が組織型相違)を認めた． 以上より，生検診断，大きさ，形状，深達度などの各因子が，内視鏡情報の一つとして総合的に判断され，EMRの適応が決定されるべきと考えられた． |
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| Theme | Expansion of Indications for Endoscopic Mucosal Resection of Early Gastrointinal Cancer | |
|---|---|---|
| Title | Indications for Endoscopic Therapy for Gastric Tumors -- Assessment of Endoscopic Findings and Histological Diagnosis Using Biopsy Samples for Extension of Indications | |
| Author | Tomoki Michida | Department of Gastroenterology, Osaka National Hospital |
| Author | Yoshiya Nishimura | Department of Gastroenterology, Osaka National Hospital |
| Author | Masahiro Ikeda | Department of Gastroenterology, Osaka National Hospital |
| Author | Toshimasa Tsujinaka | Department of Surgery, Osaka National Hospital |
| Author | Kunimitsu Kawahara | Department of Pathology, Osaka National Hospital |
| Author | Akihiko Kurata | Department of Pathology, Osaka National Hospital |
| [ Summary ] | The accuracy of endoscopic and histological diagnosis of gastric tumors, which could be treated endoscopically, was assessed. Among 122 operatively resected specimens of early gastric cancer, 89 tumors (73%) were correctly diagnosed preoperativel in terms of depth and the coincidence rate for endoscopic forceps biopsy examinations was 79%. In 96 endoscopically treated patients, with the Group III lesions, diagnosed by forceps biopsy specimens, 22 lesions(23%) were finally diagnosed as early gastric cancer, 64 lesions as adenoma and 10 lesions were seen to be regenerative atypia. The tumor size was significantly larger in the cancer group than in the adenoma group. The findings for those with a shape indicating I or IIc type and severe atypia in histology were apt to be carcinomial. In 5 out of 7 female patients the lesions were cancerous, without adenomaous elements, which means they had been diagnosed as strictly borderline lesions before endoscopic mucosal resection (EMR). In 108 early gastric cancers resected by using EMR, 7 (6%) and 6 cases (6%) were misdiagnosed histologicaly and in terms of depth respectively, before treatment. These results suggest that comprehensive consideration of the size, shape, depth, and histological examination provides correct diagnosis of gastric tumors before treatment. | |