胃癌の診断にX線検査は不要か―必須としない立場から

Is the Radiologic Examination Necessary for the Diagnosis of the Gastric Cancer?: From the Standpoint that Radiologic Examination is Unnecessary for the Qualitative Diagnosis

要旨　胃癌の診断のために，優れた2つの異質の検査法，X線検査と内視鏡検査があるが，この両者を比較して，どちらが優れているか，どちらを検査のために優先するか，どちらが必須であるか，ないか，といった問いはあまり意味がない．医師や学生を対象にした意識アンケート調査でもこのことはわかったし，検診施設での過去4年間の両検査結果からも，X線検査が不要であることを立証できない．ましてや，どちらも必須ではありえない．しかし，癌の厳密な質的診断は内視鏡生検でなければ得られないし，微小胃癌，なかでも微小Ⅱbの診断は現状では内視鏡がはるかに有利である．それゆえ，既に一般的な認識にもあるように，検査の目的に両検査法の特徴をうまく活かして，検査法を選択すべきである．

　There are two different modalities for the diagnosis of gastric cancer, i.e. radiologic and endoscopic examinations. But we do not think it would be a meaningful discussion which is superior, which should be the first, or which is more necessary. A survey of the medical students and physicians disclosed that the opinions on the necessity and superiority of the radiologic and endoscopic examinations were inconclusive. We could not prove that radiologic examination was unnecessary based on the detection rates of four-year gastric screening examinations by the endoscopic and radiologic examinations. We think both of them are necessary, but accurate qualitative examination would be made only by the endoscopic biopsy, and in detecting minute cancer especially minute type Ⅱb cancer, endoscopic examination is advantageous. Therefore, in general, the selection of examinations should be based on the objective and characteristics of examinations.