1cm以下の早期胃癌の拾い上げ―反省と対応

Detection of Early Gastric Cancer Less Than 1 cm in Diameter during Routine Radiological Examination

要旨　1cm以下の胃癌95例102病変（陥凹型77病変，隆起型25病変）を対象とし，X線の立場で拾い上げの実際と限界を検討した．陥凹型は4mm以下では拾い上げができず，5mmが限界で，5mmの8病変のうち4病変（50％），6～10mmの65病変のうち37病変（56.9％）が拾い上げられた．瘢痕を伴う34病変（sm：17）は，28病変（82.4％）が拾い上げられたが，組織型や部位には関係がなかった．瘢痕を伴わない43病変（sm：3）は，13病変（30.2％）しか拾い上げられず，うち分化型が11病変を占め，胃角部と前庭部に多かった．いずれも周囲に隆起を伴うもので，主に圧迫法で拾い上げられ，二重造影法での拾い上げは少なかった．隆起型（sm：2）は6mmが限界で，13病変（52％）を拾い上げた．Ⅰ型5病変はすべて拾い上げたが，Ⅱa型20病変では大きさ9mm，隆起の高さ0.9mm以上の8病変（sm：2）を拾い上げ，部位より肉眼型に左右され，丈の低いものは拾い上げられなかった．

　Rates of detection during roentgenological examination were investigated in 95 patients with 102 lesions (depressed type; 77 lesions, elevated type; 25 lesions) of early gastric cancer measuring 1 cm or less, and for which endoscopic resection was available.

　Among the depressed type accompanied with ulcer scar, the minimum size detected roentgenologically was 5 mm. The detection rate, regardless of site and histological type was as follows: 4 out of 8 (50%) with a size of 5 mm. 37 out of 65 (56.9%) with a size from 6 mm to 10 mm. 28 out of 34 (82.4%) lesions (sm: 17). Only 13 (30.2%) of 43 lesions (sm: 3) without ulcer scar were detected, 11 of 13 lesions were differentiated type, and 12 of them were located at the angulus and antrum. All the lesions detected radiologically were accompanied with surrounding elevation and mainly detected by the compression view.

　Among the elevated type, 13 (52%) of 25 lesions were detected roentgenologically, and 12 (48%) were detected endoscopically. The minimum size for radiological detection was 6 mm in width and 0.9 mm in height. Detectability related to the size and height rather than the site of the lesions.