胃癌の診断にX線検査は不要か―必須とする立場から：質的診断

The Importance of Radiologic Diagnosis for Determining the Depth of Gastric Cancer Invasion

要旨　胃癌の精密検査におけるX線検査の重要性について述べた．胃癌293例について超音波内視鏡と深達度診断の正診率について比較したところ，全体でX線832％，EUS78.9％であり，ほぼ同様の成績であった．X線検査はmp癌，Ⅱc型早期癌，胃角部や幽門部および前庭部に存在する病変，それに大彎側の小病変でEUSに比して深達度診断に有用であった．ただし，X線検査の質は，EUSに比べて術者の経験年数に依存する傾向を認めた．また，X線検査の活性化には術後病理像との対比による同検査法の重要性の認識，高度な撮影技術の普及，新しい診断技術の開発が必要と思われた．

　We compared the accuracy rates for radiologic diagnosis and endoscopic ultrasonographic (EUS) diagnosis of the depth of gastric cancer invasion. Two hundred and eight patients with early gastric cancer and 85 with advanced gastric cancer were examined preoperatively with both x-ray and EUS.

　Total accuracy rates in the diagnosis of the depth of invasion were 832% by x-ray and 78.9% by EUS. Radiologic diagnosis was superior in Ⅱc type, depth of invasion to the muscularis propria, location in the prepylorus, antrum, anglus, and greater curvature. However, the quality of radiologic examination was significantly dependent on the techniques of the examiner and the physique of the examinee. On the other hand, the EUS image was independent of these factors.

　We also made suggestions about promoting more frequent use of radiologic diagnosis for gastric cancer, recognition of the special merits of this diagnosis, expanding expert techniques through seeing live demonstrations or videos, developing new instruments and barium etc., and application of this method of diagnosis by young investigators.