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Workshop "Translation of the Gan Kiyaku"

J.P. Barron, R. Breugelmans

20 March 2002


Professor Patrick Barron of Tokyo Medical University presented various difficulties in translating the Guidelines for Lung Cancer (Haigan Kiyaku), published by Kanehara Shuppan in Japanese and English.

.Attendees were invited to translate short sections of the guidelines, which was followed by discussion of the difficulties encountered.

 

Following are examples of sections that were covered.

I. 内視鏡的早期肺癌の診断基準

基準A: 臨床的基準

  1. 胸部X線写真(断層,およびCT像を含む)が正常像であること。
  2. 通常の病期診断に用いられる方法(CTを含む胸部X線写真,腹部CTおよびエコー,脳CT,管シンチグラムなど)によりリンパ節および遠隔転移がないこと。

基準B: 内視鏡的基準

  1. 気管から亜区域支までに限局する。
  2. 病巣の末梢辺縁が,内視鏡的に可視できること。
  3. 病巣の長径が2cm以下であること。
  4. 組織学的に扁平上皮癌であること。

II. 内視鏡的所見

基本型と間接所見に分類する。

基本型

  1. 無所見型:内視鏡的に異常所見がなく,気管支鏡を通じて亜区域支単位あるいは区域支で行ったブラッシング等による細胞診によってはじめて局在診断された癌である。但し,TxN0M0の症例を除くものとする。
  2. 肥厚型1正常気管支粘膜よりもやや隆起した型で,気管支の分岐部で最もよく観察される。
  3. 結節型:癌病巣が,周囲と明瞭に境され,広い基部を持つ(広基性),隆起した腫瘤である。肥厚型との鑑別が難しいが,腫瘤の高さが鉗子径の短径(2mm)以上の病巣とする。

4. Bronchoscopy of Early Lung Cancer

4.1 Bronchoscopic Criteria

Clinical criteria

  1. Plain chest X-ray films, tomography and CT scans, are normal.
  2. No lymph node metastasis or distant metastasis is observed in routine clinical screening, such as chest X-ray, CT scans, abdominal CT, abdominal echo, brain CT, or bone scintigraphy.

Bronchoscopic criteria

  1. Location in subsegmental or more proximal bronchi or trachea.
  2. The peripheral margin of the tumor is visible bronchoscopically.
  3. The tumor size is less than 2 cm in greatest dimension.
  4. Squamous cell carcinoma is identified histologically.

4.2 Bronchoscopic Findings

4.2.1 Standard Findings

  1. Occult type
    Bronchoscopic findings are normal. Cytological examinations, such as bronchoscopic brushing, etc., show a localized carcinoma in the segmental or subsegmental branches.
    The category TX N0 M0, or occult carcinoma according to the stage grouping, in the TNM classification should be excluded from this type.
  2. Thickened type
    The mucosal epithelium is superficially elevated, frequently at the bifurcation.
  3. Nodular type
    The distinctive sessile lesion has a large base and elevated mucosa epithelium. The height of the elevated mucosa epithelium should be more than 2 mm.
  4. Polypoid type
    The tumor is pedunculated. Movement on respiration is useful for distinguishing between this type and the nodular type.

Combination of some features may be present.


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