胃癌スクリーニングにおける内視鏡検査の有用性―X線検査との比較から

Usefulness of Endoscopy in Screening for Gastric Cancer―Comparison with X-ray Examination

要旨　内視鏡検査による胃癌スクリーニング検査を，生検組織診断を併用しない内視鏡観察診断と定義し，219例246病変の観察診断成績と検査環境を分析した．観察診断正診率は表在型癌71.0％，非表在型癌95.5％で，癌発見ならびに観察診断成績ともに鎮痙剤未使用群で好成績であった．非正診例は，小彎および胃下部領域に多く，分化型の陥凹型早期胃癌に多い傾向がみられた．62病変の内視鏡検査成績と検診X線見直し診断の比較からは，X線的に描出困難な病変の大きさは8mm以下，X線的に質的診断が困難な病変の大きさは16mm以下であった．以上のことから，胃癌のスクリーニング検査で内視鏡が有用性を発揮するには，観察診断による大きさの目安を16mm以下の病変に求める必要があると考えられた．

　A macroscopic (visible) diagnosis and related examination in screening for gastric cancer by endoscopy without biopsy were analyzed in 246 lesions in 219 cases. The rates of correct macroscopic diagnosis were 71.0％and 95.5％in superficial and non-superficial carcinoma, respectively. The rates of correct diagnosis and detection of cancer were high, and the results of visible diagnosis were good that did not use antispasmodic agents. Diagnostic errors occurred more frequently in the area of lesser curvature and lower gastric body, and were detected at high rates in the cases of well-differentiated, type of early gastric cancer with a central depression. The outcome of endoscopic examination was compared with X-ray examination in 62 lesions. The results indicated that lesions 8 mm or less in diameter were difficult to depict, and those measuring 8-16 mm were difficult to characterize. Therefore, macroscopic diagnosis by endoscopy was more useful in screening for gastric cancer in cases with lesions measuring 16 mm or less as compared to X-ray examination.