胃集検におけるlinitis plastica型胃癌診断の現状

Current Status of the Diagnosis of Linitis Plastica Type Carcinoma of the Stomach by Mass Survey

要旨　胃集検で発見される胃底腺粘膜領域早期癌の数は近年急増しているが，linitis plastica型胃癌の発見数にはほとんど変化が認められなかった．検診発見の胃底腺粘膜領域早期癌およびlinitis plastica型胃癌の原発巣の大きさ，肉眼型，組織所見の比較検討からは，集検発見の胃底腺領域早期癌は中村らのいうlinitis plastica型胃癌の初期病変とは異なっており，現時点において，胃集検はlinitis plastica型胃癌の早期発見に大きく寄与しているとは言えなかった．更に，胃集検でlinitis plastica型胃癌の初期病変を捉えるためには間接X線写真の質を向上させることが必要条件であり，その条件が満たされたうえでlinitis plastica型胃癌死亡率減少に対する胃集検の寄与度の再評価がなされるべきであろう．また，linitis plastica型胃癌の遡及的検討で，その初期像と考えられる病変の描出が2例に認められた．

　There has been no change in the detected number of linitis plastica type gastric carcinoma in spite of the rapidly increasing number of early cancer in the fundic gland area which is detected by gastric survey with indirect photofluorography. In addition, the quality of early cancer in the fundic gland area detected by the mass survey was different from that of the initial lesion of linitis plastica type carcinoma which was reported by Nakamura in terms of size, gross and histologic findings. Consequently, the mass survey has not contributed to early detection of linitis plastica type carcinoma.

　Further improvement of direct photofluorography is required for detection of the early phase of linitis plastica type carcinoma, and the contribution of the gastric mass survey to decreasing the mortality by linitis plastica type carcinoma should be assessed in near future.

　Retrospective review of indirect photofluorography revealed 2 lesions (2 cases) which were considered to be the early phase of linitis plastica type carcinoma.