胃と腸55巻5号

2020年05月発行

増刊号 消化管腫瘍の内視鏡診断2020 主題

咽頭腫瘍性病変の内視鏡診断

著者： 菊池大輔¹ 田中匡実¹ 飯塚敏郎¹ 鈴木悠悟¹ 落合頼業¹ 野村浩介¹ 小田切啓之¹ 早坂淳之介¹ 岡村喬之¹ 團宣博¹ 光永豊¹ 山下聡¹ 松井啓¹ 渡辺健太² 武田英彦² 布袋屋修¹

所属機関： ¹虎の門病院消化器内科 ²虎の門病院耳鼻咽喉科

ページ範囲：P.472 - P.481

●「考える内視鏡診断」のポイント
･咽頭癌のハイリスク症例に対しては系統的な内視鏡観察が重要である．
･口腔底や輪状後部など観察しづらい部位があることを熟知し，発声させたりValsalva法を行ったりするなどの工夫をするべきである．
･白色光観察では扁平隆起性病変や色調変化のみの病変が多く，陥凹性病変は少ない．
･画像強調内視鏡（IEE）を用いて，brownish areaを見つけることが咽頭癌の早期発見には重要である．
･IEE拡大観察でIPCLの構造や配列，血管密度に着目することで癌か非癌かを鑑別可能である．また，日本食道学会分類を利用して咽頭癌の深達度診断も可能である．

参考文献

1）Muto M, Minashi K, Yano T, et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging：A multicenter randomized controlled trial. J Clin Oncol　28：1566-1572, 2010

2）Iizuka T, Kikuchi D, Hoteya S, et al. Endoscopic submucosal dissection for treatment of mesopharyngeal and hypopharyngeal carcinomas. Endoscopy　41：113-117, 2009

3）Iizuka T, Kikuchi D, Hoteya S, et al. Clinical advantage of endoscopic submucosal dissection over endoscopic mucosal resection for early mesopharyngeal and hypopharyngeal cancers. Endoscopy　43：839-843, 2011

4）Tateya I, Muto M, Morita S, et al. Endoscopic laryngo-pharyngeal surgery for superficial laryngo-pharyngeal cancer. Surg Endosc　30：323-329, 2016

5）石原立．咽頭・食道癌のリスクファクターとスクリーニング・サーベイランス．消内視鏡　29：1329-1333, 2017

6）Yokoyama A, Mizukami T, Omori T, et al. Melanosis and squamous cell neoplasms of the upper aerodigestive tract in Japanese alcoholic men. Cancer Sci　97：905-911, 2006

7）濱本隆夫，林隆一，宮崎眞和，他．当院における下咽頭輪状後部癌の検討．頭頸部外　25：171-176, 2015

8）川田研郎，中島康晃，東海林裕．中下咽頭の観察法と表在癌発見のコツ．消内視鏡　31：12-15, 2019

9）Yamasaki Y, Ishihara R, Hamada K. Usefulness of the Valsalva maneuver without a mouthpiece to observe the hypopharynx using transoral endoscopy. Dig Endosc　29：643-644, 2017

10）Iwatsubo T, Ishihara R, Nakagawa K, et al. Pharyngeal observation via transoral endoscopy using a lip cover-type mouthpiece. J Gastroenterol Hepatol　34：1384-1389, 2019

11）Hamada K, Ishihara R, Yamasaki Y, et al. Transoral endoscopic examination of head and neck region. Dig Endosc　30：516-521, 2018

12）Kato M, Hayashi Y, Takehara T. Valsalva maneuver to visualize the closed hypopharyngeal space during transoral endoscopy using a novel dedicated mouthpiece. Dig Endosc　31：e24-25, 2019

13）Kikuchi D, Tanaka M, Suzuki Y, et al. Utility of Valsalva maneuver in the endoscopic pharyngeal observation. Esophagus 2020［Epub ahead of print］

14）門馬久美子，藤原純子，加藤剛，他．咽頭表在癌の深達度診断．胃と腸　50：515-529, 2015

15）Inoue H, Honda T, Yoshida T, et al. Ultra-high magnification endoscopy of the normal esophageal mucosa. Dig Endosc　8：134-138, 1996

16）Inoue H, Honda T, Nagai K, et al. Ultra-high magnification endoscopic observation of carcinoma in situ of the esophagus. Dig Endosc　9：16-18, 1997

17）Kumagai Y, Sobajima J, Higashi M, et al. Angiogenesis in superficial esophageal squamous cell carcinoma：assessment of microvessel density based on immunostaining for CD34 and CD105. Jpn J Clin Oncol　44：526-533, 2014

18）Kikuchi D, Iizuka T, Hoteya S, et al. Vascular density of superficial esophageal squamous cell carcinoma determined by direct observation of resected specimen using narrow band imaging with magnifying endoscopy. Dis Esophagus　30：1-5, 2017

19）Sato H, Inoue H, Ikeda H, et al. Utility of intrapapillary capillary loops seen on magnifying narrow-band imaging in estimating invasive depth of esophageal squamous cell carcinoma. Endoscopy　47：122-128, 2015

20）Arima M, Tada M, Arima H. Evaluation of microvascular patterns of superficial esophageal cancers by magnifying endoscopy. Esophagus　2：191-197, 2005

21）Oyama T, Inoue H, Arima M, et al. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology：magnifying endoscopic classification of the Japan Esophageal Society. Esophagus　14：105-112, 2017

22）Kikuchi D, Iizuka T, Yamada A, et al. Utility of magnifying endoscopy with narrow band imaging in determining the invasion depth of superficial pharyngeal cancer. Head Neck　37：846-850, 2015

23）Katada C, Okamoto T, Ichinoe M, et al. Prediction of lymph-node metastasis and lymphatic invasion of superficial pharyngeal cancer on narrow band imaging with magnifying endoscopy. Auris Nasus Larynx　47：128-134, 2020

24）Eguchi K, Matsui T, Mukai M, et al. Prediction of the depth of invasion in superficial pharyngeal cancer：Microvessel morphological evaluation with narrowband imaging. Head Neck　41：3970-3975, 2019

25）Imai T, Ito S, Oikawa T, et al. Risk factors for cervical lymph node metastasis in endoscopically resected superficial hypopharyngeal cancers. Auris Nasus Larynx　46：424-430, 2019