胃と腸51巻12号

2016年11月発行

今月の主題 十二指腸の上皮性腫瘍

主題

十二指腸上皮性腫瘍の内視鏡診断─NBI拡大内視鏡を用いた十二指腸非乳頭部腫瘍の診断

著者： 菊池大輔¹ 布袋屋修¹ 飯塚敏郎¹ 和田有美子¹ 鈴木悠悟¹ 野村浩介¹ 栗林泰隆¹ 鳥羽崇仁¹ 田中匡実¹ 山下聡¹ 古畑司¹ 松井啓¹ 三谷年史¹ 井下尚子² 貝瀬満¹

所属機関： ¹虎の門病院消化器内科 ²虎の門病院病理部

ページ範囲：P.1566 - P.1574

文献概要

要旨●十二指腸非乳頭部腫瘍に対する関心が高まるなかで，その内視鏡診断には明確な基準がないのが現状である．胃や大腸のようにNBI拡大観察で個々の微細模様や微小血管の異型から診断すると内視鏡診断と病理診断に乖離が生じることを経験する．筆者らは，微細模様が単一なパターンで構成（mono type）されるか，複数のもので構成（mixed type）されるかに着目した診断基準を提唱した．今回この診断基準に対するvalidation studyとして検討を行った．mixed typeであるときにVienna classification Category 4以上の異型と診断した際の，感度は87.8％（36/41），特異度は45.5％（5/11）であり，正診率は78.8％（41/52）であった．NBIを用いて病変全体の微細模様を拡大観察することで，内視鏡治療適応か否かの選別ができる可能性が示唆された．

参考文献

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