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Stomach and Intestine(Tokyo) Volume 22, Issue 2 （February 1987）

胃と腸 22巻2号（1987年2月発行）

Japanese English

今月の主題陥凹型早期胃癌の深達度診断

主題

陥凹型早期胃癌の内視鏡的深達度診断―X線検査との対比を含めて Endoscopic Diagnosis of Depth Invasion in Depressed Type Early Gastric Cancer: Including Comparative Study with Roentgenography 早川和雄 ¹ , 橋本光代 ¹ , 吉田行哉 ¹ , 星原芳雄 ¹ , 山田直行 ¹ , 伊藤喜一 ¹ , 福地創太郎 ¹ , 惣名司 ² , 七海暁男 ³ , 海上雅光 ⁴ Kazuo Hayakawa ¹ ¹虎の門病院消化器科 ²虎の門病院内視鏡室 ³虎の門病院放射線診断学科 ⁴虎の門病院病理学科 ¹Department of Gastroenterology, Toranomon Hospital pp.143-160

発行日 1987年2月25日 Published Date 1987/2/25

DOI https://doi.org/10.11477/mf.1403112204

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要旨　陥凹型早期胃癌311病変，および陥凹型進行癌478病変について，術前のX線および内視鏡診断と病理組織学的診断を対比すると共に，X線および内視鏡フィルムの見直しを行い，胃癌の深達度診断の可能性と限界を追求した．また，内視鏡による深達度誤診例を病理組織学的に検索し，深達度診断に関与する諸因子につき検討した．陥凹型全胃癌に対する内視鏡の深達度誤診率は8.1％，X線の誤診率は8.7％で，著明な差はなく，早期癌と進行癌に分けても，両者に著明な差はなかった．内視鏡フィルムの見直しにより，全早期癌の約92％を，全進行癌の約96％を正診しうる可能性が推定された．内視鏡で進行癌を早期癌と誤診した病変の約25％は，X線検査が進行癌と正診し，内視鏡の誤診をカバーしうる可能性を示唆した．しかし，逆に内視鏡で正診し，X線が深達度を誤る例もあった．内視鏡で早期癌を進行癌と誤診した原因の85％は，潰瘍化に伴う強い線維化と，sm深層まで強く浸潤した癌によるものであった．他方，進行癌を早期癌と誤診した主な原因は，sm，pmに少量の癌細胞が散在性に浸潤することにあった．

　Three hundred and eleven lesions of depressed type early gastric cancer and 478 lesions of depressed type advanced gastric cancer were studied to compare preoperative x-ray and endoscopic diagnoses with pathological findings in order to define capabilities and limitations in diagnosing depth invasion of gastric cancer. Furthermore, the cases erroneously diagnosed endoscopically were investigated pathologically to determine the factors contributing to the diagnosis of depth invasion.

　Endoscopy and x-ray did not differ significantly in proportion of erroneous diagnosis occurring in 8.1% and 8.7%, respectively, as a whole. The same was true when considered separately for early and advanced gastric cancer.

　Retrospectively, however, it was estimated that about 92% of early gastric cancer and about 96% of advanced cancer can be correctly diagnosed by endoscopy. Almost 25% of advanced cancer erroneously diagnosed as early cancer by endoscopy were diagnosed correctly by x-ray, which suggests a supplementary role of x-ray in this setting. There were cases, however, in which the reverse was true, i.e., depth of invasion was correctly diagnosed only by endoscopy.

　Extensive fibrosis associated with ulcer formation and cancer invasion deep in sm accounted for 85% of the cases with early cancer erroneously diagnosed as advanced cancer by endoscopy, whereas scattered cancer cells in sm and pm accounted for the most of the cases with advanced cancer erroneously diagnosed as early cancer.