早期胃癌臨床診断の実態

Diagnostic Review of Early Gastric Cancer

　Ⅰ．早期胃癌発見例数と内視鏡検査の年次別推移

　私達の施設で癌部門が発足したのは昭和36年4月である．昭和40年5月癌部門の拡張が行なわれ，昭和43年4月には施設集検が併設された．

　早期胃癌の年次別発見例数は次頁表2のごとく昭和30年代では年間ほぼ10例前後であったが，昭和40年を境として飛躍的に増加し，昭和41～43年頃では年間40例を越え，昭和44年以降は60例以上となっている．

　It was one year prior to the establishment of macroscopic type classification for early gastric cancer by Japanese Endoscopic Society that the cancer department was opened in the Center for Adult Diseases, Osaka. Since then 327 cases of early gastric cancer were detected and surgically resected in the hospital by the end of 1970.

　Annual number of operations for early gastric cancer was about 10 in the firs several years but after biopsic method under direct vision was devised in 1965, the number of operation by the year has remarkably increased, reaching to above 60 in the last 2 years.

　The number of examinations by gastrocamera and gastrofiberscopic biopsy with cytology has also grown year by year and in recent years we have 5,000 and 1,000 cases of examinations, respectively. The latter procedure became not only more objective and precise but also more operative since the introduction of color TV in Nov. 1968, initiated for the first time in the world.

　Study of preoperative endoscopic diagnoses in the 327 cases shows that 22 (7％) had been diagnosed as benignancy or weak suspicion of malignancy, finally brought to operation by further minute examinations. After introduction of biopsy under direct vision, these cases have decreased year after year, but recently they again tend to increase. This is certainly not due to the underestimation of endoscopic findings, but it should be interpreted as to earlier detection of cancer.

　Thirty erroneously diagnosed cases, either malignant or strongly suspicious of malignancy in preoperative endoscopic diagnosis, proved to be benign by postoperative pathological survey. Their proportion to detected early gastric cancer was 9 to 100 They were mainly large polyps or active gastric ulcers.

　After the introducton in 1965 of biopsy under direct vision, they have become very rare, but yet false positive case in biopsy or cytology was not reduced to zero.

　In the review of 327 early gastric cancer cases concerning the depth of involvement, 79％ of them were diagnosed as “early” by endoscopic examination and reliability of “early” by endoscopic findings was 82％. It is becoming better year by year.