胃と腸56巻7号

2021年06月発行

今月の主題 食道胃接合部腺癌の診断2021 主題

食道胃接合部腺癌の組織型診断—内視鏡の立場から

著者： 池之山洋平¹² 藤崎順子¹ 河内洋³⁴ 中野薫³⁴ 並河健¹

所属機関： ¹がん研究会有明病院消化器内科 ²三重大学医学部附属病院光学医療診療部 ³がん研究会有明病院臨床病理センター病理部 ⁴がん研究会がん研究所病理部

ページ範囲：P.957 - P.967

要旨●背景：食道胃接合部（EGJ）腺癌の術前組織型診断精度は明らかでない．ME-NBIによる術前組織型診断能，生検による術前組織型診断能をそれぞれ検討した．方法：EGJ腺癌114例116病変を対象とした．組織型を純分化型，純未分化型，組織混在型（分化型優位），組織混在型（未分化型優位）に分類し，術前のME-NBIによる組織型診断，生検による組織型診断と切除標本組織型の一致率をそれぞれ検討した．また，切除標本中の粘膜内未分化型癌成分の有無と粘膜下層（SM）浸潤率の相関について検討した．結果：各組織型別一致率は純分化型〔ME-NBI：99.0%（102/103）vs. 生検：98.1%（101/103），n.s.）〕，組織混在型（分化型優位）〔ME-NBI：66.7%（8/12）vs. 生検：16.7%（2/12），p<0.05）〕，組織混在型（未分化型優位）〔ME-NBI：0%（0/1）vs. 生検：0%（0/1），n.s.）〕であった．SM浸潤率は未分化型癌成分（＋）群のほうが，未分化型癌成分（−）群より有意に高かった〔（76.9%（10/13）vs. 16.5%（17/103），p<0.001）〕．結論：純分化型病変はME-NBI，生検，いずれのモダリティでも高精度な術前組織型診断ができた．一方，組織混在型病変については，ME-NBIのほうが生検より組織型診断一致率が有意差を持って高かった．このことから，ME-NBIで詳細に観察し，適切な生検部位を選定した上で採取する必要があると言える．また，切除標本中に粘膜内未分化型癌成分が含まれると有意にSM浸潤率が高かった結果も踏まえると，術前に詳細な組織型診断をすることが重要であると考えられた．

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