臨床経過からみた胃生検診断の問題点―隆起型異型上皮巣の経過を中心に

Issues of Diagnostic Gastric Biopsy from a Viewpoint of Clinical Course

要旨　臨床経過からみた胃生検診断の問題点として，隆起性病変の中で，特に境界病変の生検GroupⅢの推移を1年以上経過観察し，胃切除または内視鏡的切除が施行された症例を検討した．生検診断がGroupⅢからⅤに変化した早期胃癌3例，GroupⅢのまま推移し，病変の増大を示したⅡa様異型上皮巣の1例，ならびに内視鏡的切除を施行した隆起型異型上皮巣の7例を提示した．臨床経過中の生検診断GroupⅢ→Ⅴの変化に対する臨床的対応については，lcm前後の小病変では内視鏡的切除が可能であり，2～3cmの病変で増大を示すものには，組織学的に高分化型腺癌の早期癌の併存が認められ，胃切除と共に内視鏡的切除を伴う胃部分切除の縮小手術が検討されよう．

　In order to highlight issues of diagnostic gastric biopsy in the context of clinical course, discussions were made on the surgically or endoscopically treated cases of borderline lesion of the stomach, i.e., GroupⅢ by biopsy, whose clinical courses were followed for more than a year. They included 3 cases of early gastric cancer in which GroupⅢ lesion progressed to GroupⅤ, a case of Ⅱa-like atypical epithelial lesion without malignant transformation, and 7 cases of elevated atypical epithelial lesion endoscopically removed. Review of those of malignant transformation from GroupⅢ to Ⅴ by biopsy in the clinical course indicated that endoscopic removal was possible for small lesions of about 1.0 cm in size and that gastrectomy or partial gastrectomy with endoscopic removal should be considered for lesions of about 2-3 cm, increasing in size, because of accompanying early cancer of highly differentiated adenocarcinoma in histology.