臨床経過からみた胃生検組織診断の問題点―胃陥凹性病変について

Issues on Histological Diagnosis of Depressed Gastric Lesion by Endoscopic Biopsy: Viewpoint of Clinical Course

要旨　臨床経過からみた胃生検組織診断の問題点は，一般的な胃生検組織診断の問題点と同一であった．問題点の第1は，人為的ミスであり，次いで生検組織診断基準そのものにあった．人為的ミスは病変組織の見落とし，異常所見の過剰評価と過少評価の3つがあった．組織診断基準の問題点として，組織異型度判定にのみ比重が置かれていること，組織異型度の記述が不明確であること，癌，特に分化型癌が高異型度と低異型度に区別されていないこと，Group分類の運用，特にGroupⅢのそれに異質病変を含める人があること，Group分類とdysplasia分類の大きな差，が挙げられた．

　Issues on histological diagnosis of depressed gastric lesion by endoscopic biopsy are related to the two main areas; misdiagnosis by pathologist and histological criteria used.

　Pathologist's misdiagnosis can occur due to oversight, overdiagnosis or underdiagnosis. Causes of such a misdiagnosis were elucidated in this paper by comparing original diagnosis using endoscopic biopsy specimens with that using surgically obtained materials.

　Histological criteria used also pose some problems; (1) too much emphasis on histological atypia, (2) lack of distinctive or objective description of histological atypia, (3) lack of consideration about two types of atypia of cancer tissue, i.e., low-grade and high-grade atypias, and (4) a significant difference between histological criteria adopted by Japanese Group Classification and that by European and American Dysplasia Classification.