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The Index and Accuracy in the Diagnosis of Advanced Gastric Cancer Simulating Early Cancer Tsutomu Hamada 1 1Department of Gastroenterology, Juntendo University School of Medicine Keyword: 早期胃癌類似進行癌 , 陥凹型早期胃癌 , 胃癌肉眼分類 , X線診断 pp.1429-1440
Published Date 1990/12/25
DOI https://doi.org/10.11477/mf.1403111764
  • Abstract
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 A macroscopical criteria of the so-called advanced gastric cancer simulating early cancer were tentatively established as an independent category of depressed type advanced cancer. One hundred and three lesions of type 5 advanced cancer accounted for 22.8% of the all advanced cancers experienced in the period of 1978-89. Forty-five lesions of advanced cancer which had converging folds but lacked Borrmann type mound-like elevation were compared with early cancers with converging folds. (These lesions were described radiologically as m 96, sm 91, and adv 45.)

 When surrounding elevation was the only index of diagnosis, misdiagnosis might have occurred in 4.8% of early cancers and 68.9% of advanced cancers. On the other hand, when converging fold was used as the only index, misdiagnosis might have occurred in 29.9% and 35.6%, respectively. When these two indices were used simultaneously, 73.3% of advanced cancers were diagnosed correctly. (Marked converging fold associated with ulcer is thought to indicate the presence of histological change in the proper muscle layer or below from it.) However, 26.7% (13 lesions) of advanced cancers were diagnosed as an early cancer even if both of these indices were used simultaneously. Such misdiagnosis occurred in the following cases; 5 cases with microscopic invasion into pm: 4 cases with massive invasion below pm in C area: 2 cases with easy expansion: 2 cases with the lesion on the lesser curvature and accompanying converging fold.

 Thus, macroscopic criteria of advanced cancer simulating early cancer should be the lesions of depressed type cancer accompanying marked converging fold or surrounding elevation. As a result, the depth of invasion in the gastric wall might be estimated based on the depth of histological change in the case with deep ulcer.


Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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