微小胃癌の診断学的問題点―主としてX線の立場から

Diagnostic Problems in Minute Gastric Cancer: Chiefly from a Standpoint of Radiography

要旨　術前に診断されたか，または切除標本で肉眼的に識別可能な微小胃癌51病変を対象として病理学的特徴像と診断の実状を分析し，それに基づき微小胃癌発見のための指標を考察した．①微小胃癌で悪性を疑わせる像は，小区1個単位における段差と細りであり，この所見が隣接する小区間で融合し明瞭な悪性像となる．②ルーチンX線検査による拾い上げ診断能は術前で32％，見直しで約60％であった．③精密X線検査では全病変がほぼ肉眼像に近い形で描出できたが，肉眼像よりむしろX線像のほうが悪性像を読みやすい病変があった．この最大の原因は再生上皮の影響と考えられた．④X線検査で微小癌を見つけるには小区像の読める二重造影像を撮ることが基本であり，小区1個単位の綿密な読影が必要である．

　The subject of this study is 51 lesions of minute gastric cancer the diagnosis of which had been made preoperatively, or the lesions of which were recognizable on the resected specimen. Pathologically characteristic features and corresponding radiographic or endoscopic findings were analized. Diagnosability and diagnostic problems of minute gastric cancer were also studied. Results obtaiend were as follows.

　1. The fundamental features suggestive of minute gastric cancer are lowering and slendering of an area gastricae. Coalescence of such changes in each area gastricae yields more obvious features of malignancy.

　2. The lesions could be picked-up on a routine x-ray examination in 32％ of cases prior to operation, and in 60％ on a review after operation.

　3. On detailed x-ray examination all of lesions could be demonstrated as precisely as they could by macroscopic appearance. In some of the lesions radiography was more suggestive of malignancy than macroscopic appearance. This seems chiefly due to the influence of regenerative epithelia.

　4. The fundamentally important thing for detecting a minute gastric cancer is to take a fine double contrast film in which area gastricae is recognizable, and to precisely discern any fine changes in each area gastricae on the x-ray films.