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Chronological Changes in the Endoscopic Diagnosis of Early Gastric Cancer K. Takagi 1 , Y. Ikeda 2 , A. Fuchigami 3 , A. Fujii 3 1Dept. of Surgery, Cancer Institute Hospital 3Dept. of Internal Med., Cancer Institute Hospital pp.331-338
Published Date 1972/3/25
DOI https://doi.org/10.11477/mf.1403109056
  • Abstract
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 Trends and changes seen in the endoscopic diagnosis of early gastric cancer have been studied with pivots of investigation centered on the two periods when its macroscopic classificatication was adopted and when gastric biopsy was introduced. During the time 1957~1970, 398 cases were tentatively diagnosed as early cancer by endoscopy. Of these, 276 (69%) were confirmed as such after the surgical correction, and 66 (17%) as advanced cancer, 56 (14%) as benign lesions.

 On the other hand, 109 presumed advanced cancer cases proved to be early ones after the operation, accounting for 25 per cent of a total of 439 postoperatively confirmed early cancer cases.

 Presumptive benign lesions preceding the surgery turned out to be early cancer in 54 cases, or 12 per cent of all confirmed early gastric cancers (54/439).

 Since these figures have been drawn inclussively from our results in the past 10 years, we have divided them into four periods in order to make sure progress of endoscopy and to observe the effects of gross classification and succeeding gastric biopsy on the diagnosis of early gastric cancer.

Period Ⅰ: before the macroscopic classification (~1961; gastroscope and gastrocamera)

Period Ⅱ: when macroscopic classification was adopted (1962~1963; gastrocamera and fiberscope)

Period Ⅲ: gastric biopsy (first half) (1964~1966; gastrocamera, GTF and gastric biopsy)

Period Ⅳ: gastric biopsy (second half) (1967~1979; Va gastrocamera, GTF-A, gastric biopsy by fiberscope with angle device)

 Diagnostic accuracy in each of these periods has then been studied. In the period Ⅰ, when macroscopic classification of early gastric cancer was not still in effect,6 confirmed early cancer out of 14 preoperative, tentative early cancer cases were already diagnosed as mucosal carcinoma. However, analysis of its gross morphology was still insufficient, so that there were many presumed cases of advanced cancer or benign lesion to be finally confirmed as those of early cancer through operation. The period Ⅱ, when its gross classification was employed, improved our diagnostic accuracy, as not only gastrocamera but fiberscope was used as well. Of 34 presumed early cancer cases, 21 (62%) were confirmed as such after the surgical correction. As a lesion simulating a Ⅱc, reactive lymphoreticular hyperplasia was then often detected. In the period Ⅲ, when gastric biopsy got under way, 83 cases of early cancer were confirmed as such out of 125 tentative cases prior to surgery. A strong contrast was seen in the increase of confirmed benign lesions, totalling to 28 lesions, that had been suspected as early cancer. Most of them proved to be atypical epithelium, a border-line lesion between benignancy and malignancy. This still remains an unsolved issue in the histological diagnosis of tissues obtained by gastric biopsy. The period Ⅳ with the gastric fiberscope having angle device shows a rise in accuracy of preoperative diagnosis of early cancer. Of 225 cases of presumptive early cancer, 166 (74%) were confirmed as such after the surgical operation. More positive results are now secured by gastric biopsy. One problem remains still unsettled, however. The depth of cancer invasion is still hard to determine prior to surgical operation, and much remains to be further investigated.


Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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