臨牀消化器内科 Vol.28 No.13(3)


特集名 Diagnostic and Interventional EUS ― 現状と将来展望
題名 消化管病変に対するEUS-FNA
発刊年月 2013年 12月
著者 森 直樹 東京慈恵会医科大学内視鏡科
著者 今津 博雄 東京慈恵会医科大学内視鏡科
著者 田尻 久雄 東京慈恵会医科大学内視鏡／東京慈恵会医科大学消化器・肝臓内科
【 要旨 】 超音波内視鏡下穿刺吸引生検（EUS-FNA）は，消化管病変においては，悪性腫瘍の病期診断や粘膜下腫瘍の組織診断に有用であると報告されてきた．本稿では，消化管粘膜下腫瘍，とくに上部消化管粘膜下腫瘍に対するEUS-FNAについて解説する．
GIST，平滑筋腫，神経鞘腫，脂肪腫などの粘膜下腫瘍は日常の上部消化管内視鏡検査において遭遇することが多い．なかでも，GISTはmalignant potentialをもつ腫瘍であり，診断されれば外科的切除が推奨されている．EUS-FNAは低侵襲にGISTの組織診断を可能にする唯一の手段である．2cm以下のGISTの組織診断は未だに難易度が高いが，穿刺針の選択，迅速細胞診により正診率の向上が期待できる．GIST診断モダリティのさらなる発展が望まれる．
Theme Diagnostic and Interventional EUS -- Present Status and Future Perspectives
Title EUS-FNA for Digestive Tract Pathology
Author Naoki Mori Department of Endoscopy, Jikei University School of Medicine
Author Hiroo Imazu Department of Endoscopy, Jikei University School of Medicine
Author Hisao Tajiri Department of Endoscopy, Jikei University School of Medicine / Division of Gastroenterology and Hepatology, Department of Internal Medicine, Jikei University School of Medicine
[ Summary ] It has been reported that EUS-guided fine needle aspiration (EUS-FNA) is useful for N-staging of malignant GI tract lesions and diagnosis of submucosal tumors in the GI tract. The clinical impact of EUS-FNA for submucosal tumors, especially GISTs, in the upper GI tract is reviewed.
Submucosal tumors including GIST, leiomyoma, neurilemmoma and lipoma are often encountered during gastroscopic examinations. GIST submucosal tumors may have a potential for malignancy. Therefore, surgical resection is recommended for all GISTs. Only EUS-FNA can provide tissue diagnosis of GIST noninvasively with high sensitivity and specificity. However, tissue sampling of GISTs smaller than 2 cm with EUS-FNA is still challenging. Nevertheless, precise selection of needle size and on-site cytological evaluation with EUS-FNA may improve diagnostic accuracy for GISTs, even when they are small. Further development of diagnostic modalities for GIST is needed.
戻る