臨牀消化器内科 Vol.23 No.11(4)


特集名 大腸pit pattern
題名 pit patternによる癌深達度診断
発刊年月 2008年 10月
著者 唐原 健 久留米大学医学部消化器内科
著者 鶴田 修 久留米大学医学部消化器内科
著者 河野 弘志 久留米大学医学部消化器内科
著者 佐田 通夫 久留米大学医学部消化器内科
【 要旨 】 箱根合意に基づいたVI型，VN型の定義，および高度不整VI型の定義を解説し，pit patternと深達度の関係と深達度診断能を評価した．われわれは高度不整VI型を規定する因子の一つである「輪郭不明瞭」を用いて，輪郭明瞭VI型と輪郭不明瞭VI型に細分類して検討した．その結果，V型以外の98.9 %，輪郭明瞭VI型の76.3 %が浸潤距離1,000 µm未満の浅い病変で，一方輪郭不明瞭VI型の91.7 %，VN型の病変すべてが1,000 µm以上の深い病変であり，輪郭明瞭VI型と輪郭不明瞭VI型の間に有意差を認めた．また，浸潤距離1,000 µm以上の深達度診断能は感度82.8 %，特異度96.8 %，陽性的中率93.0 %と優れた結果であった．
Theme Pit Pattern Classification in colorectal Lesion
Title Efficacy of Subclassification of Type VI Pit Patterns, Employing Magnifying Endoscopy for Diagnosis of Early Colorectal Cancer Invasion Depth
Author Takeshi Tobaru Division of Gastroenterology, Department of Medicine,Kurume University School of Medicine
Author Osamu Tsuruta Division of Gastroenterology, Department of Medicine,Kurume University School of Medicine
Author Hiroshi Kawano Division of Gastroenterology, Department of Medicine,Kurume University School of Medicine
Author Michio Sata Division of Gastroenterology, Department of Medicine,Kurume University School of Medicine
[ Summary ] The relationship between the subclassification of type VI pit patterns employing magnifying endoscopy and the depth of tumor invasion in colorectal tumors was analyzed.
Type VI pit patterns suggest intramucosal cancer, which is a slightly or deeply invasive cancer of the submucosa. Therefore, we classified type VI pit patterns into well-demarcated and poorly demarcated subtypes. The following results were obtained : (1) 76.3 % of well-demarcated VI lesions showed a depth of invasion of less than 1,000 µm, whereas 91.7 % of poorly-demarcated VI lesions showed a depth of invasion of over 1,000 µm. (2) The calculated accuracy, sensitivity and specificity, as well as positive predictive values, were 92.1 %, 82.8 %, 96.8 % and 93.0 % respectively, in cases where the carcinoma had invaded over 1,000 µm.
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