胃生検診断の現状と問題点―内視鏡・生検診断後のX線診断の役割

The Role of Radiological Diagnosis in Early Gastric Cancer after Endoscopy and Biopsy

要旨　今日，胃生検診断の手技，診断能については全く問題なく，どのような所見を生検すべきかについても，少しでも異常と見えるとすぐ生検するようになったので検討する課題は少ない．むしろ，あまり予想しなかった部位から生検で癌と診断された後の診断過程に問題があると考えるので，症例を挙げ診断上の問題点について述べる．〔症例1〕は胃体上部前壁の発赤を帯びた粘膜から生検がなされ印環細胞癌と診断された．境界の追える局在病変を胃内視鏡・X線検査で認めずⅡb型早期胃癌と診断したが，手術直前にX線フィルムを見直したところ壁の伸展不良に気づきlinitis plastica型癌と診断した．〔症例2〕は胃体部前壁の急性胃粘膜病変と考えられる粘膜からの生検で癌と診断された．X線診断では1枚のフィルムで表層拡大型胃癌の全貌を表すことができた．〔症例3〕は胃体下部小彎に潰瘍を認め，周囲からの生検で癌と診断された．X線診断は噴門部まで拡がるⅡc＋Ⅲ型早期胃癌であった．口側切除線の決定にX線診断は有用であった．このように胃X線診断は内視鏡・生検診断後にも全体像を表すといった点で，依然として大きな意義を持っている．

　There are few unsolved, technical problems in the diagnosis of gastric cancer from biopsy specimens. Moreover, discussion about from what kinds of abnormal endoscopic findings biopsies should be taken seems nonexistent because biopsies can be made from even slightly suspicious pathological lesions.

　However, after an unexpected cancer is found through biopsy, there are sometimes considerable problems involved if further accurate diagnosis is to be made.

〔Case 1〕A 48-year-old man. In reddish inflammatory mucosa on the anterior wall of the gastric body, cancer cells were found in biopsy, but there was no area that could be demarcated as a cancer, so the initial diagnosis was Ⅱb type of early cancer. On the films of gastric radiology, the finding of wall rigidity was seen, and the linitis plastica type of gastric cancer was able to be correctly diagnosed.

〔Case 2〕A 66-year-old woman. Biopsy revealed cancer cells taken from reddish, granular mucosa in the anterior wall of the gastric body. Endoscopic examination did not show the whole figure of the lesion, but a double contrast radiograph demonstrated the complete figure.

〔Case 3〕A 58-year-old man. Cancer cells were found in the biopsies from around an ulcer on the lesser curvature of the lower gastric body. Double contrast radiograph showed faint barium flecks spreading to the cardia from the edge of the ulcer. These three cases show that radiology still has importance even after endoscopic and biopsy diagnosis.