胃と腸57巻13号

2022年12月発行

今月の主題 IEEを使いこなす 主題

NBIおよびBLIを使いこなす—大腸

著者： 小林輝¹ 斎藤彰一¹ 鈴木桂悟¹ 十倉淳紀¹ 安江千尋¹ 井出大資¹ 千野晶子¹ 五十嵐正広¹ 河内洋²

所属機関： ¹がん研究会有明病院下部消化管内科 ²がん研究会有明病院病理部

ページ範囲：P.1657 - P.1664

要旨●大腸腫瘍の質的（腫瘍/非腫瘍，良悪性）および深達度診断において，JNET分類の有用性とJNET Type 2Bの診断能について検討した．進行癌を除く，内視鏡的または外科的切除が施行された大腸腫瘍性病変3,834病変を対象とし，JNET分類で評価を行った．結果，Type 1は，HP，SSLを含む鋸歯状病変が98.8%を占めており，Type 3では98.0%がpT1b癌であった．またType 2Aは，腺腫およびpTis癌が95.4%を占めていた．Type 2Bには，腺腫からpT1b癌まで幅広い腫瘍性病変が含まれていた．さらに，Type 2Bと診断した病変のうち，クリスタルバイオレット染色にてV_I高度不整を呈したものは73.1%と高い確率でpT1b癌であった．以上よりJNET分類は大腸腫瘍性病変の質的および深達度診断に有用と考えられた．Type 2Bは腺腫からpT1b癌まで多岐にわたる組織型が含まれていたものの，Type 2BにおけるV_I型pit pattern診断はT1b癌の絞り込みに有用であることから，Type 2B病変では色素拡大観察の併用が望まれる．

参考文献

1）Sano Y, Horimatsu T, Fu KI, et al. Magnifying observation of microvascular architecture of colorectal lesions using a narrow-band imaging system. Dig Endosc　18：S44-51, 2006

2）Kanao H, Tanaka S, Oka S, et al. Narrow-band imaging magnification predicts the histology and invasion depth of colorectal tumors. Gastrointest Endosc　69：631-636, 2009

3）Wada Y, Kudo SE, Kashida H, et al. Diagnosis of colorectal lesions with the magnifying narrow-band imaging system. Gastrointest Endosc　70：522-531, 2009

4）Nikami T, Saito S, Tajiri H, et al. The evaluation of histological atypia and depth of invasion of colorectal lesions using magnified endoscopy with narrow-band imaging. Gastroenterol Endosc　51：10-19, 2009

5）Saito S, Tajiri H, Ikegami M. Endoscopic features of submucosal deeply invasive colorectal cancer with NBI characteristics：S Saito et al. Endoscopic images of early colorectal cancer. Clin J Gastroenterol　8：353-359, 2015

6）Tanaka S, Sano Y. Aim to unify the narrow band imaging（NBI）magnifying classification for colorectal tumors：current status in Japan from a summary of the consensus symposium in the 79th annual meeting of the Japan Gastroenterological Endoscopy Society. Dig Endosc　23：S131-139, 2011

7）Sano Y, Tanaka S, Kudo SE, et al. Narrow-band imaging（NBI）magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc　28：526-533, 2016

8）浦岡俊夫，東玲治，大原信哉，他．大腸鋸歯状病変の内視鏡診断—pit patten所見を中心に．胃と腸　46：406-416, 2011

9）Nakao Y, Saito S, Ohya T, et al. Endoscopic features of colorectal serrated lesions using image-enhanced endoscopy with pathological analysis. Eur J Gastroenterol Hepatol　25：981-988, 2013

10）Sumimoto K, Tanaka S, Shigita K, et al. Clinical impact and characteristics of the narrow-band imaging magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Gastrointest Endosc　85：816-821, 2017

11）Komeda Y, Kashida H, Sakurai T, et al. Magnifying narrow band imaging（NBI）for the diagnosis of localized colorectal lesions using the Japan NBI Expert Team（JNET）classification. Oncology　93（Suppl 1）：49-54, 2017

12）鈴木桂悟，斎藤彰一，池之山洋平，他．当院における大腸腫瘍性病変に対するJNET分類の診断成績．日大腸検会誌　36：83-89, 2020

13）Ito R, Ikematsu H, Murano T, et al. Diagnostic ability of Japan Narrow-Band Imaging Expert Team classification for colorectal lesions by magnifying endoscopy with blue laser imaging versus narrow-band imaging. Endosc Int Open　9：E271-277, 2021

14）Higurashi T, Ashikari K, Tamura S, et al. Comparison of the diagnostic performance of NBI, Laser-BLI and LED-BLI：a randomized controlled noninferiority trial. Surg Endosc　36：7577-7587, 2022

15）Hirata D, Kashida H, Iwatate M, et al. Effective use of the Japan Narrow Band Imaging Expert Team classification based on diagnostic performance and confidence level. World J Clin Cases　7：2658-2665, 2019

16）Sakamoto T, Takamaru H, Sekiguchi M, et al. Reliability of Japan Narrow-Band Imaging Expert Team classification for the diagnosis of colorectal neoplasms：A pilot study. Digestion　101：638-643, 2020

17）Iwatate M, Sano Y, Tanaka S, et al. Validation study for development of the Japan NBI Expert Team classification of colorectal lesions. Dig Endosc　30：642-651, 2018

18）Sumimoto K, Tanaka S, Shigita K, et al. Diagnositc performance of Japan NBI Expert Team classification for differentiation among noninvasive, superficially invasive, and deeply invasive colorectal neoplasia. Gastrointest Endosc　86：700-709, 2017