Kawano Tatsuyuki, Nagai Kagami, Nishikage Tetsuro, Kumagai Yohichi, Ogiya Kazuo, Tanaka Koji, Takeshita Kimiya
Esophagogastric Division, Department of Surgery, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
Gan To Kagaku Ryoho. 2003 Jul;30(7):909-13.
Although the possible existence of micrometastasis in superficial esophageal cancer cases is the most important factor in deciding the therapeutic strategy, it is difficult. There are also limits to the diagnosis of the depth of tumor invasion by endoscopy and EUS. Therefore, the extension of the indication of EMR is planned. Then, the complement of diagnostic ability by EMR is being tried. Sentinel lymph node (s) identification and its biopsy also seem to be useful. In advanced esophageal cancer cases, diagnostic accuracy has been improving by speedup of CT and MRI scans and various image processing technology. More accurate diagnosis of metastasis using PET is much awaited. However, there is still insufficient ability to detect micrometastasis to date. Molecular bio-markers with comprehensiveness are not a valuable selection at this stage. Although advanced equipment has brought more diagnostic accuracy, ways to integrate or use these tools at the clinical level are sought. Some equipment developing and how to integrate them and how to select the appropriate examination in each patient are problems which are required in clinical practitioners.
尽管浅表性食管癌病例中微转移的可能存在是决定治疗策略的最重要因素，但这很难判断。通过内镜检查和超声内镜诊断肿瘤浸润深度也存在局限性。因此，计划扩大内镜下黏膜切除术（EMR）的适应证。然后，正在尝试通过EMR来补充诊断能力。前哨淋巴结的识别及其活检似乎也很有用。在进展期食管癌病例中，通过加快CT和MRI扫描以及各种图像处理技术，诊断准确性一直在提高。人们迫切期待利用正电子发射断层显像（PET）更准确地诊断转移情况。然而，迄今为止检测微转移的能力仍然不足。现阶段，具有全面性的分子生物标志物并不是一个有价值的选择。尽管先进设备提高了诊断准确性，但仍在探索在临床层面整合或使用这些工具的方法。一些设备的研发以及如何整合它们，如何为每位患者选择合适的检查，是临床医生需要面对的问题。
