早期胃癌臨床診断の実態

Merits of Gastric Biopsy in the Diagnosis of Early Gastric Cancer

　東大分院外科における早期胃癌症例は，昭和36年より昭和46年10月までの間に98例である．その詳細を別表に示してある．その他内視鏡で早期胃癌を疑ったが手術の結果進展癌であったもの16例内視鏡で早期胃癌を疑ったが手術後の組織検査で良性と決定したものが4例あった．

　これらの早期胃癌症例および内視鏡で早期胃癌を疑った進展癌または良性疾患について，その診断の過程および問題点について検討を加える．

　From Jan. 1961 to Dec. 1971, 98 cases of early gastric cancer have been experienced in the Department of Surgery, Branch Hospital, Tokyo University. We have also come across 16 cases of advanced cancer first suspected as early through endoscopy, with 4 of benign lesions likewise interpreted as early cancer.

　Since 1959 cytology has been employed in our Department for the diagnosis of early gastric cancer, and from 1965 on gastric biopsy has been reinforced as well. Our present routine procedures for early-cancer-suspicious patients through endoscopy or x-ray include biopsy under direct vision and cell interpretation of stained smears of biopsied specimens.

　Good results are obtained thereby. Although biopsy under direct vision is most potent in the determination of cancer, it is to be done on the basis of endoscopy, and more efforts are needed for endoscopic confirmation of yet more minute cancer lesions.

　Qualitative diagnosis of cancer lesions to be removed has mostly be established before surgical operation, but 2 cases proved to be wrong in those not previously examined for cytology of biopsied specimens.

　The positive rate of accuracy in the diagnosis of early gastric cancer in our Department is 90.5 per cent. There are also 6 other cases of early cancer initially suspected as advanced one, so that 95 cases out of 98, or 96.5 per cent, proved correct in the qualitative diagnosis of early gastric cancer.