内镜下胃癌浸润深度诊断现状的探讨

目的早期胃癌在内镜下黏膜切除术（EMR）是越来越普及，近年来内镜下黏膜下层切开-剥离术（ESD）的出现使其适应症越来越广泛。对其适应证的选择上要求正确的内镜下浸润深度的肉眼诊断。方法日本国立癌中心中央病院过去3年（2001-2003年）在该院施行的外科方法胃切除或内镜下胃黏膜切除（EMR）的1846例（早期胃癌1258例，进展期胃癌588例）单发胃癌病例为对象，首先把胃癌浸润深度的确诊率用内镜下临床诊断（C）和切除后病理学诊断（P）两者比较来探讨；再次对早期胃癌的误诊病例，从肉眼分型、溃疡（UL）有无、部位、肿瘤大小、组织类型角度进行了误诊倾向的探讨。结果（1）内镜在早期胃癌和进展期胃癌的鉴别上，术后早期胃癌（P）和术后进展期胃癌（P）确诊率分别为95％（1199／1258）、86％（504／588）其中5％的早期胃癌被误诊为进展期，14％的浸润癌被误诊为早期胃癌；（2）对术后早期胃癌1258例探讨中对术后粘膜层癌（pM）在术前内镜下诊断为粘膜层癌（cM）、粘膜下层癌（cSM）、侵及肌层以上癌（cMP-）的病例，分别是85％（714）、14％（112）、1％（10）也就是说粘膜层癌（pM）的准确诊断率为85％；对粘膜下层癌（pSM）422例的探讨中在术前内窥镜下诊断为粘膜层癌（cM）、粘膜下层癌（cSM）、侵及肌层以上癌（cMP-）分别是42％（177）、46％（196）、12％（49），也就是说42％的粘膜下层癌（pSM）被低估诊断；（3）对早期胃癌误诊病例的探讨中；隆起型（Ⅰ、Ⅱa）病变误诊病例中77％（35／45）被低估诊断，溃疡（-）的误诊病例中68％（112／164）被低估诊断，胃体上部误诊病例中70％（53／75）被低估诊断，胃体中部误诊病例中66％（64／97）被低估诊断，肿瘤直径10mm以下误诊病例中79％（15／19），10-20mm误诊病例中67％（66

Investigate of Diagnosis of Gastric Cancer Using Endoscopy

Objective： Therapy of early gastric cancer uing EMR （endoscopic mucosal resection） is widely spreading, so, highly accurate method for detection of tumor depth is needed. Methods： 1 846 patient in National Cancer Centre Hospital of Japan, from 2001-2003, including patient of resection by surgery and by EMR, is observed. First, Comparing clinical diagnosis（c） by endoscopy and pathological diagnosis（p） by surgery; Then, divided case of erroneous diagnosis by ulcer, location, size, histology. Results： 1） When distinguish early gastric cancer and developing gastric cancer, accurate diagnosis in early gastric cancer are 95% and 86% in developing gastric cancer. 14% of developing gastric cancer is misdiagnosed as early gastric cancer. 2） When observed 1 258 case of early gastric cancer after operation, we find pM is diagnosed as cM, cSM, cMP, 85%, 14%, 1%, respectively. 3） Investigate erroneous diagnosis of early gastric cancer, 77% （35/45） of elevated pattern are under diagnosis, 68% （137/202） of ulcer pattern are under diagnosis, upper body pattern are 70% （53/75）,middle body pattern are 66%（64/97）under diagnosis, size 〈10mm are 79%（15/19）, size 10-20 mm are 67% （66/98） under diagnosis , good differentiation and middle differentiation pattern are 68% （137/202） under diagnosis. Conclusions： Although endoscopy is developed in today, we mistake in detection early gastric cancer and pSM. There are erroneous diagnosis in elevated lesions, ulcer lesions, lesions in fundus and body, size more than〈 20 mm. we must improve accurate diagnosis in endoscopy, but we ought realize limits of endoscopy in early gastric cancer.