胃と腸42巻5号

2007年04月発行

特集 消化管の拡大内視鏡観察2007 各論 4. 大腸

10) 微小血管の拡大観察　(2)NBIによる腫瘍・非腫瘍の鑑別

著者： 堀松高博¹ 工藤豊樹¹ 池松弘朗¹ 傳光義² 佐野寧¹³

所属機関： ¹国立がんセンター東病院内視鏡部消化器内科 ²獨協医科大学放射線科 ³佐野病院消化器センター

ページ範囲：P.863 - P.868

要旨　われわれは1999年より21世紀の内視鏡開発に取り組み，狭帯化filterを搭載したNBI systemを開発した．大腸病変の表面に観察される網目状の茶色い血管"meshed capillary vessel"（MC vessel）が大腸病変の腫瘍・非腫瘍の鑑別に有用な所見であると報告してきた．目的：NBI観察でのMC vesselの腫瘍・非腫瘍の鑑別における有用性を検討する．方法：prospective study．eligibility criteria：colonoscopyを施行した患者．exclusion criteria：polyp（－），invasive cancer，polyp＞10mm，他院でbiopsy（＋），HNPCC，UC，FAP，polyp未回収患者．病変はMC vesselの有無によりMC（＋）/（－）に，病理組織結果は腫瘍・非腫瘍に分類した．病理結果を正診とし，MC（＋）/（－）と病理結果において腫瘍を腫瘍と診断するaccuracy rate等を解析した．結果：criteriaを満たした92人，150病変を対象とした．NBI観察にてMC（＋）110例，MC（－）40例で，病理結果は腫瘍111例，非腫瘍39例で，accuracy rate：95.3％，sensitivity：96.4％，specificity：92.3％であった．結語：MC vesselは大腸腫瘍・非腫瘍の鑑別に有用で，NBIは色素を使用せず鑑別ができ，スクリーニングの効率化に寄与すると考えられる．

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