早期胃癌臨床診断の実態

Present Status of Clinical Diagnosis for Early Gastric Cancer

　内科医であるわれわれにとって「早期胃癌臨床診断の実態を把握することは，極めて困難である．その理由は，同じ内科の同じ研究室員が発見し，早期胃癌と診断した症例であっても，外科手術や病理学的検索は，1カ所で同じ方法で行なわれるとは限らず，種々の病院で，しかも種々の方法で行なわれるためである．従って，良性潰瘍と診断したものの中に，実際は癌であって，しかもわれわれがその間違いに気付いていない症例があることが当然予測される．これは大学病院内科，殊にその関連施設にまで診断の場を求める消化器研究室の避け難い悩みであろう．

　今回は，表記したメンバーが九大第2内科消化器研究室に在籍した期間に診断したもののうち，九大癌研病理，九大第2病理，九大第2外科，国立福岡中央病院にて病理学的検索の行なわれた症例のみを対象として，与えられた表を作製した．

　A study has been made on the clinical diagnosis of 322 early gastric cancer cases surgically removed and later confirmed as such by pathology. They were all encountered in the Department of Pathology, Cancer Institute, Kyushu University, the Second Department of Pathology of the same University and the National Fukuoka Central Hospital.

　Ⅰ. Not all of 322 cases of early gastric cancer underwent gastric resctiona after the diagnosis had been established as such, but those that proved to be so ultimately were included as well. Their preoperative diagnoses are as follows:

　　1. Of 322 cases of early gastric cancer, 273 or 84.8％, were correctly diagnosed.

　　2. Of those clinically erroneously, diagnosed only 8 cases, or 2.5％, were gastrectomized as benign lesions. The rest were dealt with as advanced cancer because of errors in determining the degree of depth invasion.

　Ⅱ. Analysis of cases first labeled as “early gastric cancer”.

　　1. Of 341 cases first diagnosed as early gastric cancer, those that were confirmed as such amounted to 273 or 80％.

　　2. Erroneous diagnoses in the nature of lesions were seen in 23 cases of ulcer lesions (6.7％), in 18 of atypical epithelium (5.2％). The others were in errors as far as depth of cancer invasion was concerned.

　　3. As ATP (Atipical epithelium) is regarded as a borderline lesion between benignancy and malignancy, it might not have been appropriate so include it in the category of benign, wrongly diagnosed cases. If it is excluded, the rate of accurate diagnosis rises up to 84.5％.

　　4. Results of diagnosis before the propagation of gastric biopsy (before 1966) and after it (since 1967) have been compared. After 1967, the rate of erroneous diagnosis in ulcer lesions went down to one third, while the number of protruded type ATP mistaken for early gastric cancer doubled.

　　5. Diagnosis of protruded ATP is for the present very difficult to arrive at.