早期胃癌臨床診断の実態

Clinical Diagnosis of Early Gastric Cancer during This Thirteen Years

　早期癌の集計は，これは，正確に扱ってきた．早期癌にかんしては，自信をもって診断の推移を考察することができる．ところが，鑑別診断の成績の一部には，集計にさいして不確かなところがある．では，フイルムを見直そうとすると，昔のフイルムは，いまではどこに行ったのかわからないという始末である．フイルム整理がよく行われていない実情が，しみじみくやまれる．あくまで正確なデーターだけを扱う立場に立つと，いいつけられた項目すべてを満たすことができない．

　早期癌分類が制定された時期は，これは万人に公平なときであったといえる．ところが，内視鏡や生検器具の使用にかんしては，万人に共通な使用開始時期というものがきめられない．なぜならばふりかえってみても，新製品の使用は，始めのうちは限られた人たちのものであった．われわれが使用できたのは，はるかに遅れた．

　We would like to discuss about the developement of x-ray examination of early gastric cancer under the influence of endoscopic and biopsy examination.

　In 1962 Japanese classification of early gastric cancer was established. Before 1962 x-ray examination and endoscopic examination were performed independently. We had no definite idea concerning relation of both diagnostic values and indication of endoscopic examination.

　During 1963～1967, both examinations were closely combined each other and made progress in both diagnostic values. Pick up x-ray diagnosis was developed from 66.7％ (before 1962) to 86.3％ (after 1962) and also detailed x-ray diagnosis from 66.7％ (before 1962) to 82.5％ (after 1962).

　From 1969 combined method of x-ray, endoscopic and biopsy examinations had been performed clinically. By this clinical method diagnostic ability was increased to 95％.

　By x-ray examination combined with endoscopic examination it was increased in number of Ⅱa and Ⅱc. Before 1962 cases of Ⅱa and Ⅱc was occupied in about 50％ in all cases of early gastric cancer cases. After 1962 percentage of detection of Ⅱa and Ⅱc was increased to 70％.

　Before 1962 we had only 3 cases of small early gastric cancer. After 1962 number of the small cases was increased to 24～30％ of all early gartric cancer cases.

　Diagnosis of the cardiac region was developed from 1969. Before 1969 we had no case of early cancer. But after 1969 we had 4 cases.

　Since 1963 we have hardly worked in x-ray diagnosis of anterior wall. By routinely used x-ray, examination of anterior wall was developed by combined endoscopic examination. In the present time, we can easily detect the lesions of anterior wall using remote X-TV in routine screening.