胃癌診断におけるルーチン検査の確かさ―内視鏡検査（panendoscopy）からみて

Accuracy of Panendoscopy as the Routine Screening Method for Early Detection of Gastric Cancer

要旨　1979～1984年に当科で初めて胃癌と診断された例でpanendoscopyによるルーチンのスクリーニングが行われた例に，他院で癌を疑われながらpanendoscopyでそれを見逃した例を含めた，早期胃癌54例，進行胃癌42例を対象とした．2年以内に癌なしとされながら診断時に20mm以上の早期胃癌であったもの，および4年以内に癌なしとされた進行胃癌例を見逃し例として算定すると，ルーチン検査としてのpanendoscopyで早期胃癌を発見する確からしさ（有病正診率）は77.4％であった．C領域と大彎の病変ではやや劣る．panendoscopyは早期胃癌を発見するために十分な確からしさを有する．

　Among 131 cases of proven early gastric cancer which were newly detected in our hospital, 92 cases were subjected to routine panendoscopy as the first line of examination. There were another four cases who were referred to us with suspicion of gastric cancer but our panendoscopy failed to detect it. These 96 cases (54 early, 42 advanced cancers) were subjected to this study. In another one case of generalized metastases, panendoscopy was unable to detect its primary focus of type Ⅱb in the upper body of the stomach. This case was included in the overlooking ones.

　In panendoscopy every part of the stomach, duodenal cap and esophagus was photographed using 40 frames. Endoscopic diagnosis was settled in a conference attended by all endoscopists by reviewing the photo-documentations, visual findings and the report of pathologists when biopsy was performed.

　When early cancer over 20 mm in size was detected within two years after negative panendoscopy for cancer and advanced cancer within four years, these cases are defined as the overlooking of early gastric cancer. Then the accuracy of panendoscopy for the early detection of gastric cancer (sensitivity) is 77.4%. It is somewhat lower for the cancer in the upper third of the stomach and major curvature. If panendoscopy will be performed annually, the accuracy would become 92%. Routine panendoscopy is satisfactory enough for early detection of gastric cancer.