1982年度における胃癌診断の実態―オフィスコンピューターによる診断情報システムについて

Actual Condition of the Diagnosis of Gastric Cancer: Analysis by office computer

　過去においても，現在においても，胃癌の診断を論ずる場合の常套手段は確定診断がなされた症例，あるいは手術が施行された症例に基づいて，その診断過程を逆追跡し，診断成績を検討する方法である．単に発見した癌の数や個々の症例の質によって診断の優劣を競うのであれば，このような方法にも意義は認められよう．しかしながら，胃癌のスクリーニング法としてX線か内視鏡かの二者択一を迫られるような，かつては想像もしなかった局面を迎えている現状においては，発見した癌の数や症例の質を吟味すると同時に，癌が発見されてきた背景を詳細に分析することが必要であると思われる．

　1981年6月，オフィスコンピューターを導入しようと思い立ち，消化管のX線および内視鏡診断の情報処理を行う計画を練ったのは，胃癌が診断されてくる背景，言い換えれば，一定期間内に行われたすべての検査（X線，内視鏡）について，時間の要素を加味した診断の流れを把握したいという願望があったからである．

　Actual condition of the diagnosis of gastric cancer was analyzed with the use of oflice computer (IBM System/34), based on 11,243 cases out of 13,251 x-ray examination sand 4,112 cases out of 5,782 endoscopic examinations which were performed at the Cancer Institute Hospital, Tokyo in 1982, and the following results were obtained.

　1. In the cases diagnosed as early cancer by x-ray, biopsy confirmed malignancy in 24.5% (34/139) of those examined with remote-controlled x-ray apparatus (XR) and in 66.0% of those examined with ordinary apparatus with I. I. In the cases diagnosed as advanced cancer by x-ray, biopsy confirmed malignancy in 49.2% of those examined with (XR) and in 71.7% (76/120) of those examined with (XD).

　2. In the cases suspected of early cancer by x-ray, biopsy confirmed malignancy in only 1.8% (9/498) of those examined with (XR) and in 12.0% (6/50) of those examined with (XD).

　3. In 134 cases of cancer confirmed by biopsy examination was started with (XR), and 28 cases (20.9%) were not diagnosed as cancer nor cancer-suspect. In 102 cases of cancer confirmed by biopsy examination was started with (XD), and 12 cases (11.8%) were not diagnosed as cancer nor cancer-suspect. In many cases with such negative diagnoses the diagnosis of cancer was not made by the following endoscopy.

　4. In most cases of cancer malignancy was confirmed by biopsy in the second or third step of examination.

　5. Fiberscopy and biopsy were recommended as the second step of examination for the cases which were diagnosed as cancer or cancer-suspect in the initial x-ray examination. It was suggested that further consideration should be necessary as to the sequence of examination until surgery after confirming malignancy by biopsy.