臨牀消化器内科 Vol.21 No.4(6)


特集名 拡大内視鏡の現況と問題点
題名 拡大内視鏡を用いた早期胃癌の診断 -- Narrow Band Imagingを併用した拡大内視鏡所見
発刊年月 2006年 04月
著者 藤崎 順子 癌研有明病院消化器病センター
著者 石山 晃世志 癌研有明病院消化器病センター
著者 斉藤 充生 癌研有明病院消化器病センター
著者 高橋 寛 癌研有明病院消化器病センター
著者 星野 惠津夫 癌研有明病院消化器病センター
著者 加藤 洋 癌研有明病院病理部
【 要旨 】 早期胃癌における，Narrow Band Imaging (NBI) を併用した拡大内視鏡による表面毛細血管パターン，表面微細構造には特徴的な所見があった．表面毛細血管パターンでは，高分化型腺癌では網目型，中分化型腺癌では楕円型，低分化型腺癌では不規則，と特異的な血管パターンを呈した．拡大内視鏡にNBIを併用し，表面の毛細血管パターンを検討することで，組織型の予測が可能である．血管パターンをメルクマールにして，癌の境界診断を行うと陥凹型での範囲診断に有用であった．また生検で胃腺腫と診断された62症例のなかで，網目，楕円，不規則などの血管パターンを示す症例は44例あり，そのうち37例 (84％) が腺腫内癌，高分化型腺癌であった．
Theme Current Status of Magnifying Endoscopy
Title Diagnosis of Early Gastric Cancer with Magnifying Endoscopy, Emphasizing Use of Magnifying Narrow Band Imaging
Author Junko Fujisaki Division of Endoscopy, The Cancer Institute Ariake Hospital, Japan Foundation for Cancer Research
Author Akiyoshi Ishiyama Division of Endoscopy, The Cancer Institute Ariake Hospital, Japan Foundation for Cancer Research
Author Mitsuo Saito Division of Endoscopy, The Cancer Institute Ariake Hospital, Japan Foundation for Cancer Research
Author Hiroshi Takahashi Division of Endoscopy, The Cancer Institute Ariake Hospital, Japan Foundation for Cancer Research
Author Etsuo Hoshino Division of Endoscopy, The Cancer Institute Ariake Hospital, Japan Foundation for Cancer Research
Author Yo Kato Division of Pathology, The Cancer Institute Ariake Hospital, Japan Foundation for Cancer Research
[ Summary ] Narrow Band Imaging (NBI) is a newly developed device, which produces information on the microvascular structures of the GI mucosa. One aim of this study is to investigate the usefulness of magnified NBI for more accurate endoscopic diagnosis of early gastric cancer. The structures of magnified NBI were classified as follows ; fine-network, oval, spiral, and irregular patterns. Well differentiated adenocarcinomas typically showed fine network patterns. Moderately differentiated adenocarcinomas typically showed oval or spiral patterns. Poorly differentiated adenocarcinomas typically showed irregular patterns. The margin of the cancer was more clearly defined in cases of depressed type (“IIc”) early gastric cancer. We evaluated information about gastric adenoma as diagnosed with biopsy. 44 out of 62 cases showed a fine network, with oval and irregular vascular pattens. 37 (84%) cases were diagnosed as cancer in cases of adenoma or well differentiated adenocarcinoma after EMR or ESD.
Magnified NBI observation was useful for pretreatment and histological evaluation of early gastric cancer and for accurate demarcation of the margins of depressed type (IIc) early gastric cancers.
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