臨牀消化器内科 Vol.30 No.9(2-2-2)


特集名 大腸LST(側方発育型腫瘍)の新展開
題名 LSTの深達度診断 b. EUS 診断
発刊年月 2015年 08月
著者 清水 誠治 大阪鉄道病院消化器内科
著者 吉田 直久 京都府立医科大学消化器内科
著者 富岡 秀夫 大阪鉄道病院消化器内科
著者 上島 浩一 大阪鉄道病院消化器内科
著者 福田 亘 大阪鉄道病院消化器内科
著者 横溝 千尋 大阪鉄道病院消化器内科
【 要旨 】 大腸側方発育型腫瘍(LST)におけるEUSの深達度診断の意義について述べた.LST自験例68例で20MHz細径超音波プローブ(MUSP)を用いて検査を行った.症例の内訳は顆粒型42病変(顆粒均一型11病変,結節混在型31病変),非顆粒型26病変である.深達度をSM軽度浸潤以浅とSM高度浸潤以深に分け,EUS診断と組織診断が一致したものを正診とした.MUSPによる深達度正診率は全体で76.5%であり,正診できなかった原因はすべて描出不良(超音波減衰,貯水不能,垂直断層像描出不能)であった.顆粒均一型では正診率が高いが,SM癌は含まれておらず,EUSは基本的に不要と考えられた.LSTはタイプにより病変の発生部位や浸潤様式が異なっており,EUSの必要性,難易度を考慮して施行する必要がある.
Theme New Development of Laterally Spreading Tumor
Title Diagnosis of Infiltration Depth of Colorectal Laterally spreading Tumors with EUS
Author Seiji Shimizu Division of Gastroenterology, Osaka General Hospital of JR West Railway Company
Author Naohisa Yoshida Department of Gastroenterology, Kyoto Prefectural University of Medicine
Author Hideo Tomioka Division of Gastroenterology, Osaka General Hospital of JR West Railway Company
Author Koichi Uejima Division of Gastroenterology, Osaka General Hospital of JR West Railway Company
Author Wataru Fukuda Division of Gastroenterology, Osaka General Hospital of JR West Railway Company
Author Chihiro Yokomizo Division of Gastroenterology, Osaka General Hospital of JR West Railway Company
[ Summary ] We evaluated the efficacy of endoscopic ultrasound (EUS) for the diagnosis of cancer infiltration depth in colorectal laterally spreading tumors (LST). Sixty‒eight lesions were examined with a 20 MHz miniature ultrasonic probe (MUSP). The series included 39 granular‒type lesions (11 homogenous, and 28 nodular mixed types) and 24 non‒granular type ones. The depth of invasion was divided into SM‒slight ≥ and SM‒massive ≤, and the EUS and histological diagnoses were compared. The infiltration depth was correctly diagnosed using MUSP in 76.5 % of patients. Diagnostic failures were due to poor visualization caused by echo attenuation, failure to fill the lumen with water, and inability to obtain perpendicular cross‒sectional images. Submucosal or deeper levels of invasion were not identified in the granular type lesions, and EUS is considered unnecessary for this type. Since the site of involvement and the mode of invasion differ according to the macroscopic type of LSTs, the indications for EUS should be determined after considering its necessity and difficulty.
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