The Study on the Scopic Biopsy of the Gastric Cancer
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概要
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It was confirmed experimentally using 10 mature dogs that the scopic biopsy of the stomach by the forceps could be done successfully in yielding sufficient tissue for diagnosis without the risk.Then, the punch biopsy of the stomach under the observation with B type of F. G. S. was performed on 185 patients of the gastric cancer.<BR>The results:<BR>1) The correct diagnosis of the gastric cancer with the scopic biopsy could be made on 156 cases among total of 185 cases (84.3%).Restricting to the early stage of the gastric cancer, the ratio became 26/28 (92.9%).<BR>2) The percentages finding out the gastric cancer by the scopic biopsy were relatively low in type I and IV of Borrmann's macroscopic classification.There was not observed a high correlation between the spread of lesions and the possibility of the correct diagnosis of the gastric cancer.<BR>3) Concerning the locations of the gastric cancer the correct diagnosis was easily made in the cases with the lesions at the lesser curvature of the inferior portion of the stmach body (97.1%), while it was difficult (66.7%) for example at the lesser curvature adjacent to the cardia, the anterior wall of the antrum or the pyloric canal, and generally at the greater curvature.<BR>4) It was effective to take from 3 to 5 pieces of tissue from thelesions, avoiding to make the biopsy at the same location.<BR>5) The relationship between the size of specimen and the possibility of the correct diagnosis of the gastric cancer was not recognized.If the several pieces of specimen with the diameter ranging from 1 to 4 mm were collected on one case, the hit percentage became 53.4-58.6%. Referring to the layers from which the specimen was taken there was only a small difference of the hit percentages between the pieces of specimen with (59.4%) or without (52.0%) muscularis mucosae.It can be suggested that the other than gastric mucosa is not neccessarily required for the biopsy diagnosis of the gastric cancer.<BR>6) The percentages finding out the gastric cancer by the biopsy became as high as 53.8-73.1%, if the specimen was taken at the retracted portion or the edge of the concave form (II or III) of the early gastric cancer or at the top or the inner side of the thickened border surrounding the malignant ulcer (II or III type of Borrmann's classification);while the confidence of the diagnosis was obliged to turn vague if it was taken from theulcer floor covered by the necrotic degenerative tissue.<BR>7) There was no accident such as haemorrhage or performation among 197 patients to whom the scopic biopsy of the stomach was performed.Only the slight fever was recognized in 2 cases.<BR>8) As the factors leading to the misdiagnosis of the gastric cancer, the location of the lesions in the stomach was enumerated.As above-mentioned, at the adjacent portion to the cardia or at the greater curvature side of the antral region, the collection of the specimen is often failed because of the difficulty in handling of the B type F.G.S. or the forceps. The percentages of the correct diagnosis became also low, if the specimen was taken from the necrotic ulcer floor, the outer side of the thickened border of the ulcer or the surface of the tumor.The scopic observation was occasionally disturbed by haemorrage or refluent bile.<BR>9) The scopic biopsy was considered to be very important for the diagnosis of the gastric cancer especially in earlier stage, as the other methods such as roentogenographic, endoscopic or cytologic examinations.
- 財団法人 日本消化器病学会の論文
財団法人 日本消化器病学会 | 論文
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