胃良・悪性境界病変の生検診断の問題点―長期臨床経過からみて

Issues of Gastric Biopsy for Diagnosis of Benign/Malignant Borderline Lesion: From the Viewpoint of Long-term Clinical Follow-up

要旨　初回生検でGroupⅢの診断を受け，その後手術あるいは内視鏡的切除により確定診断の得られた35例を対象として，胃生検診断GroupⅢの問題点について検討した．最終診断は13例が腺腫で術前生検診断も全例GroupⅢであった．また，1例に増大傾向を認めた以外に形態的にも変化は認められなかった．残る22例の最終診断は癌で，初回内視鏡の肉眼型は多くが扁平隆起で，色調も褪色調であったが，10例で色調は均一ではなく一部に発赤が認められた．経過観察中に形態変化を呈したものは7例で，増大と共に発赤の出現や結節状の変化が認められた．経過中，平均4.4回の生検が施行され術前生検診断がGroupⅤとされたものが12例，Ⅳが7例で，生検という限られた組織での診断の困難さが示唆された．GroupⅢという生検診断のみに頼りすぎることなく，組織異型を伴うものや形態変化を呈する例では積極的に内視鏡的切除の適応とすべきと考えられた．

　To evaluate group Ⅲ lesions initially diagnosed by biopsy specimen, 35 lesions which were definitively confirmed by surgically or endoscopically resected specimens were analyzed. Endoscopic appearance of 12 0ut of 13 adenomas did not change during the follow-up period.

　Twenty two lesions were finally diagnosed as carcinomas. Initial endoscopic examination showed that most of them were flat but elevated and discolored lesions, but 10 lesions also had localized redness. Seven lesions changed in size and shape; redness and nodular change appeared on their surface. As an average, 4.4 biopsies were performed during the follow-up period. Twelve lesion transformed into group Ⅴ, and 7 lesions into group Ⅳ. It was speculated that the initial biopsy specimens might not be large enough to detect carcinoma. Thus it seemed to be critically important to perform endoscopic resection to the questionable lesions as well as to consider the endoscopic and histological findings, or repeat biopsy.