超拡大内視鏡(Endocytoscopy system)による食道病変の診断  [in Japanese] ULTRA-HIGH MAGNIFICATION ENDOSCOPY (ENDOCYTOSCOPY SYSTEM) FOR EXAMINATION OF ESOPHAGEAL LESIONS  [in Japanese]

Access this Article

Search this Article

Author(s)

    • 熊谷 洋一 KUMAGAI Youichi
    • 埼玉医科大学総合医療センター 消化管・一般外科 Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University.
    • 川田 研郎 KAWADA Kenro
    • 東京医科歯科大学 食道外科 Department of Esophageal and General Surgery, Tokyo Medical and Dental University.
    • 田久保 海誉 TAKUBO Kaiyo
    • 東京都健康長寿医療センター研究所 Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology.
    • 石田 秀行 ISHIDA Hideyuki
    • 埼玉医科大学総合医療センター 消化管・一般外科 Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University.

Abstract

<p>Endocytoscopy system(ECS)は2003年に細胞レベルまで拡大可能な超拡大内視鏡として試作機1号が開発された.現在の第4世代ECSはHi-vision画像で連続して500倍までの拡大が可能となり,市販可能なレベルに到達している.</p><p>食道におけるECS観察を効率的に運用するためにType分類を提案した.Type1:核密度が低く観察される扁平上皮細胞はN/C比が低く核異型のないもの.Type2:核密度は高く,細胞間の境界が不明瞭になっているが核異型が弱い.Type3:核密度が高く核異型が観察される.Type3を悪性とすると内視鏡医の診断は感度93.6%,特異度94.0%であり,病理医の判定は感度93.6%,特異度98.8%であった.</p><p>食道に対するECS診断はOptical biopsyを実現し生検診断省略を可能にする.しかし,あくまで表面から見た病理診断であり限界も熟知する必要がある.</p>

<p>We report in detail the progress that has been made in the development and use of the endocytoscopy system (ECS), and introduce the ECS appearance of various esophageal lesions.</p><p>The first-generation ECS was developed in 2003 as an ultra-high magnification endoscope (fixed focus, probe) allowing magnification to the cell level. The latest (fourth-generation) ECS offers a hi-vision view with a consecutive increase in magnification to ×500. This ECS makes it possible to observe features at the "conventional endoscopy level", "microvasculature level" and "cell level" through a gradual increase in magnification using a hand lever during the same examination.</p><p>For observation of cells using ECS, vital staining with toluidine blue, etc., is necessary. In the esophagus, cell staining can be observed just after spraying the dye into the esophageal lumen. After vital staining, it is possible to observe cells on the mucosal surface by bringing the lens of the ECS into contact with the target mucosa.</p><p>We propose a type classification to distinguish malignant lesions from benign lesions efficiently : (1) Type 1, surface epithelial cells have a low nucleus/cytoplasm (N/C) ratio and a low cell density. No nuclear abnormality is evident. (2) Type 2, there is a high nuclear density but no evident nuclear abnormality. No clear borders between cells are evident. (3) Type 3, evidently increased nuclear density and nuclear abnormality.</p><p>On the basis of in vivo observation, the sensitivity and specificity of ECS for malignant lesions by an endoscopist were 93.6% and 94.6%, respectively, if Type 3 was considered malignant. With regard to a pathologist's interpretation of the ECS images, the sensitivity and specificity for malignant lesions were 93.6% and 98.8%, respectively. On the basis of ECS images, neither the endoscopist nor the pathologist was able to clearly distinguish regenerative squamous epithelium in gastroesophageal reflux disease and esophagitis after radiotherapy from esophageal cancer. In such cases, histological examination of biopsy specimens would be necessary in addition to ECS diagnosis.</p><p>ECS observation of esophageal lesions will facilitate "optical biopsy", and allow omission of histological examination of biopsy specimens in many cases. However, as ECS observation is limited to observation of cells on the mucosal surface, this must be recognized as a limitation of this new technology.</p>

Journal

  • GASTROENTEROLOGICAL ENDOSCOPY

    GASTROENTEROLOGICAL ENDOSCOPY 59(2), 207-218, 2017

    Japan Gastroenterological Endoscopy Society

Codes

  • NII Article ID (NAID)
    130005241446
  • Text Lang
    JPN
  • ISSN
    0387-1207
  • Data Source
    J-STAGE 
Page Top