胃と腸53巻5号

2018年05月発行

増刊号 早期胃癌2018

主題

─早期胃癌の診断の基本─画像強調内視鏡診断:診断体系と臨床応用

著者： 八尾建史¹ 長浜孝¹ 植木敏晴² 岩下明德³

所属機関： ¹福岡大学筑紫病院内視鏡部 ²福岡大学筑紫病院消化器内科 ³福岡大学筑紫病院病理部

ページ範囲：P.611 - P.620

文献概要

要旨●画像強調併用拡大内視鏡による早期胃癌診断の基本を示す目的に，VS classification systemの原則について概説し，それをもとに作成した本邦の統一診断体系であるMESDA-Gを紹介した．基本的な臨床応用として，質的診断と早期胃癌の境界診断について，高いエビデンスにより，画像強調併用拡大内視鏡検査による早期胃癌診断の有用性が検証されていることについて論じた．また，有用性のみでなく，限界についても明らかにし，限界例を考慮した臨床的対応（strategy）を提示した．具体的には，質的診断における表面平坦型または表面陥凹型の褪色調粘膜病変については限界であり，生検を省略できない．それ以外の病変については，MESDA-Gによる質的診断を行うとoptical biopsyとなりうると考えられる．境界診断については，未分化型癌が限界であり，境界診断については周囲の非癌粘膜からの生検の病理組織診断により境界診断を行うことが必要と考えられた．分化型癌については，画像強調併用拡大内視鏡や色素撒布法と同等の高い有用性がある．観察法の限界を知り，それを考慮した適切な臨床的対応をすることが重要である．

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