胃螢光洗浄細胞診

Cytological Diagnosis of Gastric Cancer by Means of Fluorescent Lavage Method

　最近の細胞化学的染色法などの発展にともなって，もはや胃の細胞学的診断法は完成の域に達したかの感がある．また種々の細胞採取法とくに内視鏡器具の改良によって，現在では諸氏の報告をみても非常に高い診断適中率がえられている．しかしいずれの場合にも細胞の形態学的な事項が根底をなし，細胞鑑別の重要な因子となるのはいうまでもない．すなわち胃癌のみならず胃潰瘍，胃炎，ポリープなどの良性疾患の際にも著しく異型度の強い細胞が出現するのは周知のとおりである．acridine orange染色法は1924年にStruggerによって考案され，1956年Bertalanffyによって細胞学的診断法に応用されるようになった．この染色方法の特徴はacridine orange色素が細胞内の核蛋白と結合しDNAは緑色にRNAは赤色に染まるため，細胞診にもちいると悪性細胞は螢光輝度が強く良性細胞と容易に区別でき，弱拡大のscreeningも簡単である点にあるとされている．筆者らは細胞診screeningをより迅速にしかもより正確にしようと試み，細胞採取と同時に細胞が染色される方法（筆者らはこの方法を胃螢光洗浄細胞診と呼んでいる）を考案したが，手技も簡単で診断成績も良好，しかも経済的な方法であるのでここに報告する．

　A new method of staining cells simultaneously with obtaining them has been devised in order to save time necessary for cytological diagnosis and to improve its results. The authors have named it as fluorescent lavage method for cytological diagnosis of the stomach, applying it to the study of gastric cancer. The staining and lavage fluid is comprised of 100 ml of acetic acid buffer solution (pH 6.3) in which 1 capsule of Kim opsin is dissolved with 200 ml of 0.5% acridine orange solution. It can be applied to lavage under direct vision and to that by means of gastric catheter hitherto used. The excised specimen may be observed in an unfixed state, but it is seen to better advantage when fixed by Cytospray. Findings by fluorescent microscope are the same as those by acridine orange staining method; the specimens are beautiffuly stained, being most suitable for screening under low magnification. Cells of gastric cancer are easily found as their nuclei and nucleoli are enlarged and fluorescent brightness is intense.

　The advantages of this method are: (1) the time for staining cells is saved because it is simultaneous staining and obtaining of cells, so that it is unnecessary to stain cells afresh: (2) the possibilty of overlooking pathologic cells is far lessened because cells of the same specimen can be stained again by another method: (3) it is suitable as well for microscopic study of specimens associated with intense bleeding due to lavage under direct view, since the erythrocyte is not stained by acridineorange. As inexpensive as it is, it is not inferior to any other staining method in the accuracy of results obtained.

　The number of cases experienced as yet amounts to only 34. Diagnostic accuracy shall be much increased in future.