| 特集名 | 大腸側方発育型腫瘍（LST）─ 新たな時代へ | |
|---|---|---|
| 題名 | LSTに対する内視鏡診断 ─ 現状と限界 | |
| 発刊年月 | 2014年 01月 | |
| 著者 | 前山 泰彦 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部内科学講座消化器病センター |
| 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／久留米大学医学部内科学講座消化器病センター |
| 著者 | 野田 哲裕 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部内科学講座消化器病センター |
| 著者 | 長田 修一郎 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部内科学講座消化器病センター |
| 著者 | 河野 弘志 | 聖マリア病院消化器内科 |
| 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／久留米大学医学部内科学講座消化器病センター |
| 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／久留米大学医学部内科学講座消化器病センター |
| 【 要旨 】 | 当施設の過去の検討で，LST-G（LST-granular type）は腫瘍径が大きくなるに従い担癌率が上昇し，LST-NG（LST-non granular type）は小さい病変においても担癌率が高く，深部浸潤率も高値であった．通常観察における深達度診断の指標として緊満感を伴う二段隆起または陥凹内隆起が重要であった．pit patternは，LST-G-M（LST-granular-nodular mixed type）で結節の上に潰瘍を伴うようになると，その部分はⅤN型を呈し，SM深部浸潤である．また，LST-NG-PD（LST-non granular-pseudo-depressed type）が癌化してくると，その部位でⅤI型やⅤN型を呈することがある．NBIでは，LST-NG-PD型SM癌で血管が疎になることが多い．また，SM浸潤部が表面に露出したSM癌ではsurface patternが認識されなくなる．超音波内視鏡は，リンパ濾胞や線維化などによる第3層内の低エコーが深達度の過大評価につながるため注意を要する． | |
| Theme | Laterally spreading tumor (LST) -- Toward a new era | |
|---|---|---|
| Title | Endoscopic diagnosis of LST -- Present situation and limitations | |
| Author | Yasuhiko Maeyama | Division of Gastroenterology, Department of Medicine, Kurume University Suhool of Medicine / Department of Endoscopy, Center for Gastroenterology, Kurume University Suhool of Medicine |
| Author | Osamu Tsuruta | Division of Gastroenterology, Department of Medicine, Kurume University Suhool of Medicine / Department of Endoscopy, Center for Gastroenterology, Kurume University Suhool of Medicine |
| Author | Tetsuhiro Noda | Division of Gastroenterology, Department of Medicine, Kurume University Suhool of Medicine / Department of Endoscopy, Center for Gastroenterology, Kurume University Suhool of Medicine |
| Author | Shuichiro Nagata | Division of Gastroenterology, Department of Medicine, Kurume University Suhool of Medicine / Department of Endoscopy, Center for Gastroenterology, Kurume University Suhool of Medicine |
| Author | Hiroshi Kawano | Department of Gastroenterology, St. Mary's Hospital |
| Author | Keiichi Mitsuyama | Division of Gastroenterology, Department of Medicine, Kurume University Suhool of Medicine / Department of Endoscopy, Center for Gastroenterology, Kurume University Suhool of Medicine |
| Author | Michio Sata | Division of Gastroenterology, Department of Medicine, Kurume University Suhool of Medicine / Department of Endoscopy, Center for Gastroenterology, Kurume University Suhool of Medicine |
| [ Summary ] | We previously reported that larger lesions are associated with early cancer and are higher in patients with LST-G. On the other hand, LST-NG are associated with smaller lesions than LST-G. Rates of invasive cancer were higher than observed with LST-G. Investigation of macroscopic findings of invasive cancer revealed lesions exhibiting elevation with swelling. These are a very important sign for diagnosis of invasive cancer. Tubercles associated with LST-G-M and ulcers, and VN type pit patterns, may indicate a diagnosis of invasive cancer. VI type or VN type pit patterns associated with LST-NG-PD may indicate a diagnosis of invasive cancer. The NBI method may be employed to treat invasive LST-NG-PD cancer exhibiting avascular patterns. When invasive cancer appears on the surface of lesions, the surface pattern of those lesions can not be recognized. Use of EUS in hypoechoic third layer areas to treat lymph follicle or fibroid lesions, may lead to overestimation in diagnosis of invasive cancer. |
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