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多段階発癌説の考え方に基づき,気管支上皮から前癌状態である扁平上皮化生・異形成を経て扁平上皮癌が発症すると考えられている.病理学的な診断に基づく異形成と上皮内癌の鑑別は経験豊富な病理診断医に頼らざるを得ない.しかしその診断基準は普遍的なものであろうか.肺末梢病巣では小型な細気管支肺胞上皮癌では癌であっても経過観察が推奨される場合が出てきている.気管支壁内病巣の生物学的特性を評価し,その気管支壁内病巣が治療を必要とする病巣か否かを判断すべきである.細胞増殖能・変異p53蛋白質の発現・細胞間接着能の欠損などがその評価対象となりうると考えられ,特にこのような変化は基底膜近傍から起きていることが示された.(気管支学.2006;28:601-606)
According to the hypothesis of multi-step carcinogenesis, we believe that squamous cell carcinoma appears in bronchial epithelium through the precancerous lesion (squamous metaplasia and dysplasia). We cannot distinguish in-situ carcinoma from dysplasia without a skillful diagnosis by experienced pathologists. However, such a pathological diagnosis is a universal criterion, isn't it? Recently, it is recommended that a small-sized bronchioloal-veolar carcinoma in the peripheral lung is enough for follow-up examinations, even though its lesion is recognized as a cancerous lesion. When we evaluate the necessity of therapeutic treatments of the intrabronchial lesion, we should regard the biological characteristics as important. We attempted to evaluate the biological characteristics of the intrabronchial lesions using cell proliferation, mutant p53 protein expression and the deficiency of cell to cell adhesion ability, and we concluded that these changes initially occurred in the neighborhood of the basement membrane. (JJSRE. 2006;28:601-606)
