内視鏡診断技術の進歩に伴う食道癌の診断について

抄録

Since 1964, 597 patients with esophageal cancer have been examined by the fiberoptic esophagoscope at our center.
Since 1973, as a result of recent advance in fiberoptic esophagoscopy, some new diagnostic techniques have been elaborated, which are as follows; Lugol solution spreading method, clipmarking method, tattooing method, intraluminal U-turn technique, and boring biopsy.
Since 1973, 240 cases have been examined by these new endoscopical techniques for the diagnosis of esophageal cancer.
Lugol solution spreading method is an application of Shiller's method which had first been used in the field of gynecology. This method is very useful for discerning the existance of intraepithelial cancer. Iodine stains normal epithelium into a brownish colour, but the epithelium replaced by cancer cells is not stained because it lacks glycogen.
Nowadays using these new techniques, a-factor (depth of cancer invasion) and n-factor (tendency of metastasis or malignancy) are able to be determined before treatment.
A-factor is determined by calculation of length of the tumor, degree of circular invasion and “submerging rate”.
The clinical characteristics of malignancy of esophageal cancer are obtained by integrating the following five factors; the form of the margin, intraepithelial invasion, diffuse invasion into lamina propria or submucosal layer, skipping metastasis, and type of invasion.
The malignancy of esophageal cancer is expressed as the diagnostic malignant point. The relationship between the diagnostic malignant point and survival period after successful treatment of esophageal cancer was discussed in our patients. These were divided into three groups; the highly malignant group, the intermediate group, and the least malignant group. In the highly malignant group, no patient survived more than one year after treatment. A new treatment needs to be developed for patients in this group.
All of those who survived more than one year belonged to the least malignant group.