微小胃癌のX線診断―肉眼所見との対比から

Radiological Diagnosis of Minute Gastric Cancer－Comparison with Macroscopic Observation－

要旨　癌巣の大きさが5mm以下の微小胃癌277病変を対象として，臨床的発見の難易さおよびX線的発見の指標を検討した．①臨床的発見頻度は9.4％（26病変）で，微小胃癌のほとんどは詳細な組織学的検索（全割標本）による発見である．②肉眼ならびに臨床的発見の難易さは，組織割面形態と癌巣の大きさに左右されるが，癌巣の大きさが3mm以下（特に1～2mm）では組織割面形態とは無関係に発見は困難である．③X線的に発見するためには，透視下の観察と撮影を併用し，小さなニッシェや透亮像および局所的な胃小区の粗大化の所見を見落とさないようにし，大小彎側に存在する病変では側面像で胃辺縁の異常を丹念に探す必要がある．

　Two hundred and seventy-seven cases of minute gastric cancer which was defined by the size, 5 mm or less in diameter, were examined with respect to indices leading to its detection clinically or radiologically.

　The results were as follows.

1) Only 9.4％ (26 lesions) of minute gastric cancer were found clinically. On the other hand, most of the cases were diagnosed by histological examination of whole section.

2) Although macroscopic and clinical diagnosis of minute gastric cancer depended on the size of lesion and the morphology in cross section, detecting the lesion smaller than 3 mm (especially 1～2 mm) was difficult irrespective of the morphology.

3) In order to find minute gastric cancer, small niche, radiolucency, and rough area gastricae should not be overlooked by closely observing under fluoroscopy and radiograms. Lateral views, in particular, should be carefully examined to detect lesions of the greater or lesser curvature.