胃生検でGroup Ⅴと診断された症例の臨床的対応―陥凹型病変を中心に

Clinical Management of Patients Diagnosed as Having Group Ⅴ Stomach Cancer: With Special Reference to Depressed Type

要旨　胃生検組織診断は，多くの場合決定的な最終診断となる．その結果，逆に本来の内視鏡検査の意義が軽視されている感じを受ける．最近5年間に当院でGroup Ⅴと診断された717例のうち，陥凹型病変について，その臨床的対応の問題点について述べた．その要点は次の4点である．①717例中1例は“ひとかき癌”（=生検で癌が消失した病変）の可能性があるが，厳重に経過観察中である．②717例中6例（0.8％）は組織型診断に問題があった．特に，悪性リンパ腫が低分化腺癌と診断されたものが2例あった．③癌の悪性度診断も行われつつある．④日本の一般病理医間に診断能力の差がある．最も重要なことは，臨床と病理の良好な関係を築くことである．

　Histological diagnosis made by using biopsy samples is regarded as the final diagnosis of gastric diseases in most cases. For this reason, endoscopic examination is sometimes given less importance than it deserves. This paper reviews problems related to clinical management of depressed type lesions in 717 patients diagnosed as having Group Ⅴ stomach cancer in this hospital in the last five years. Four points must be emphasized. 1) Since the possibility of “one-scratch cancer”(a lesion that can be eliminated during biopsy) could not be excluded in one of the 717 patients. This patient is being closely followed up. 2) Histological diagnosis was questionable in six of the 717 patients (0.8％), and it is particularly problematic that malignant lymphoma was diagnosed as being poorly differentiated adenocacinoma. 3) Recently, the degree of malignancy is determined, and 4) There are considerable differences in the ability to make accurate diagnosis among general pathologists in Japan. It is most important to establish a good cooperetive relationship between clinicians and pathologists.