| 特集名 | 大腸癌画像診断の最先端 | |
|---|---|---|
| 題名 | 3. 大腸癌の質的・量的診断 (1) 拡大内視鏡による大腸癌の質・深達度診断 | |
| 発刊年月 | 2009年 03月 | |
| 著者 | 長谷川 申 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 鶴田 修 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 河野 弘志 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 唐原 健 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 吉森 建一 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 白土 睦人 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 有田 桂子 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 桑木 光太郎 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 光山 慶一 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 著者 | 佐田 通夫 | 久留米大学医学部内科学講座消化器内科部門／同消化器病センター内視鏡診療部 |
| 【 要旨 】 | 拡大観察下の，(1) クリスタルバイオレット染色によるpit patternと，(2) Narrow Band Imaging (NBI) system下での微細血管粘膜模様診断による大腸上皮性腫瘍の質・深達度診断能の比較検討を両観察を施行した131 病変を対象として行った．pit pattern診断における質診断能（癌と腺腫の鑑別）は，全体正診率73.3％，癌診断の感度50.8％，特異度97.1％，陽性的中率97.0％であるのに対し，微細血管粘膜模様診断では全体正診率72.5 ％，癌診断の感度63.5％，特異度85.3％，陽性的中率80.0％であった．次にpit pattern診断における（腺腫，pM～pSM-s 癌とpSM-m 以深癌の鑑別）深達度診断能は全体正診率83.2％，pSM-m 以深癌診断の感度63.0％，特異度88.5％，陽性的中率81.0％ であるのに対し，微細血管粘膜模様診断における深達度診断能は全体正診率90.8％，pSM-m 以深癌診断の感度55.6％，特異度100％，陽性的中率100％であった．今回の検討にて両診断法とも異型度を低く読む傾向があること，深達度に関して微細血管模様診断は“浅読み”する傾向があることが示唆された．また微細血管粘膜模様診断はpit pattern診断が判定不能な病変の診断において補助的な役割を果たしうる可能性が示唆された． | |
| Theme | Frontier of image diagnosis for colorectal carcinoma | |
|---|---|---|
| Title | Endoscopic diagnosis of colorectal tumor | |
| Author | Shin Hasegawa | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Osamu Tsuruta | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Hiroshi Kawano | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Takeshi Tobaru | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Kenichi Yoshimori | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Mutsuhito Shiratsuchi | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Keiko Arita | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Kotaro Kuwaki | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Keiichi Mitsuyama | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| Author | Michio Sato | Division of Gastroenterology / Division of GI Endoscopy, Department of Medicine, Kurume University School of Medicine |
| [ Summary ] | We conducted a retrospective study on the effectiveness of endoscopic diagnosis（ histological diagnosis and diagnosis of invasion depth） using two magnifing endoscopic modes. One method employed staining with crystal violet (crystal violet staining method) and the other was a method which used the NBI (NBI method). The following results were obtained : The crystal violet staining method, had a calculated accuracy, sensitivity and specificity for histological diagnosis, which 73.3% , 50.8% and 97.1% respectively. The calculated accuracy, sensitivity and specificity for determining depth were 83.2%, 63.0% and 88.5% respectively. For NBI method, the calculated accuracy, sensitivity and specificity for histological diagnosis were 72.5% , 63.5% and 80.0% respectively, with calculated accuracy, sensitivity and specificity for depth of 90.8%, 55.6% and 100% respectively. The crystal violet staining method has been shown to have high rates of effectiveness for diagnosis of colorectal tumor through endoscopy. In this study, we found the NBI method to also be effective. However, our results showed that both methods were likely to indicate lesions to be more benign than histological diagnosis. The NBI method indicated lesions to be less deep than histological diagnoses. Therefore, we suggest that the NBI method may be more useful for diagnosis than the crystal violet staining method, when one can not see the surface of lesions because of blockage to views from obstructions such as mucus. |
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