臨牀消化器内科 Vol.25 No.3(3)


特集名 食道・胃の前癌病変,高発癌状態をめぐって
題名 まだら食道と食道癌 -- ヨード不染帯の鑑別診断
発刊年月 2010年 03月
著者 飯塚 敏郎 虎の門病院消化器科
著者 菊池 大輔 虎の門病院消化器科
著者 布袋屋 修 虎の門病院消化器科
著者 矢作 直久 虎の門病院消化器科
【 要旨 】 ヨード染色を行った場合に遭遇する不染帯は,癌を含めたhigh grade intraepithelial neoplasia(HGIN)が多くを占めるものの,炎症性変化に起因する場合も少なからず認められる.その鑑別としてはpink color signが一つの指標となる.その感度は91%,特異度は94%であった.また不染帯の大きさで分けると5 mm以下の場合HGINである可能性が低い.したがって,HGINと鑑別を要するヨード不染帯は,不整形を呈する5 mm以上のもので,周囲にわずかな濃染帯を有するような境界明瞭な不染を呈し,さらに時間経過でpink color signを呈する病変と考えられる.
Theme Precancerous Conditions and Cancer High-risk Lesions in the Esophagus and the Stomach
Title Differential Diagnosis of Iodine -- unstained Areas
Author Toshiro Iizuka Department of Gastroenterology, Toranomon Hospital
Author Daisuke Kikuchi Department of Gastroenterology, Toranomon Hospital
Author Shu Hoteya Department of Gastroenterology, Toranomon Hospital
Author Naohisa Yahagi Department of Gastroenterology, Toranomon Hospital
[ Summary ] During endoscopic examination with iodine staining, various degrees of iodine-unstained areas were often found. Histologically, those areas are diagnosed as regions of inflammation, low grade intraepithelial neoplasia, high grade intraepithelial neoplasia (HGIN) or invasive cancer. Clinically, it is required that we distinguish various types of inflammatory lesions such as reflux esophagitis, non reflux esophagitis or radiation induced esophagitis from HGIN in terms of endoscopic features for iodine-unstained areas. For differential diagnosis, pink colored areas are one useful indicator. The sensitivity of this technique was 91.9%, and the specificity was 94%. The size, shape, and the demarcation of the iodine-unstained areas are also important. All these factors should be taken into consideration when target lesions are biopsied.
戻る