進行胃癌を見逃さない検査法

Methodology to Avoid Missing Advanced Gastric Cancer

要旨　当センターにおいて，X線検査→内視鏡検査という診断過程の中で発見された進行胃癌は306例あり，そのうち見逃し例は9例（X線7例，内視鏡2例）あった．また，約4,000人の同一集団の8年間の逐年検診で発見された胃癌46例のうち進行癌は6例あり，前回の検査で見逃されている（X線4例，X線・内視鏡1例，生検誤診1例）．これらの見逃し例の検討から次のような結論を得た．①X線の見逃しは胃上部，前壁およびⅡc類似が多く，内視鏡の見逃しはlinitis plastica型癌が多い．②見直し診断では検査不良と読影不注意がほとんどを占める．胃上部および前壁撮影改善のために，高濃度バリウムの開発が急がれる．③逐年検診では，内視鏡の巧みな組み合わせが早期癌発見率を高め，進行癌の見逃しを少なくする．

　In the diagnostic process of x-ray through endoscopy at our center, 306 cases of advanced cancer have been detected. Nine cases of them were missed (7 by x-ray, 2 by endoscopy).

　On the other hand, in a given group of around 4,000 examinees who have been supervised under consecutively performed annual checks for 8 years, 46 gastric cancers have been detected. These included 6 advanced cancers which had been missed in the previous examination (4 by x-ray, 1 by x-ray through endoscopy, and 1 by biopsy).

　Analysis of the missed cases mentioned above led to the following conclusions;

　1) Missing by x-ray was more likely to be committed in the upper part or in the anterior wall site, especially in case of Ⅱc-like advanced carcinomas. Missing by endoscopy was more common in the linitis plastica type.

　2) When reviewed retrospectively, missing was closely associated with inadequate examination and inattentive reading. The manufacture of more highly concentratd barium meals is needed for better visualization in order to avoid the pitfalls mentioned here.

　3) In consecutively performed annual cheks, pertinent combined use of endoscopy and x-ray is recommended to increase the rate of early cancer detection, and to decrease the number of occasions when advanced cancer is missed.