Diagnosis of Early Gastric Cancer Seen as Less Malignant Endoscopically

Jn order to make the endoscopic diagnosis of early gastric cancermore accurate, we determined the endoscopic and clinicopathologicalcharacteristics of the 129 cases of early gastric cancer withless malignant appearance among the 978 cases of the diseasewith a solitary lesion detected at the National Cancer CenterHospital during the period between 1962 and 1981. Accordingto findings required to make a differential diagnosis, the endoscopicappearance of the 978 cases were divided into the followingfour groups: 170 cases of polypoid, 587 of ulcerative, 119 ofgastritis-like and 102 of advanced cancer-like. Among the fourgroups, the frequency of cases with less malignant appearancewas quite high in the gastritis-like group. The lesion in thisgroup was defined as the cancerous lesion which shows only superficialmucosal abnormality, not associated with any polypoid or ulcerativecomponents. Chronologically, it has been rapidly increasingin recent years. These two paradoxical phenomena in the gastritis-likegroup, that is, "high frequency of less malignant appearance"and "increase in number of cases" not only indicate the inadequacyof the conventional criteria for the recent cases but also showthat the gastritis-like malignancy is detectable. New additionalendoscopic criteria for the gastritis-like malignancy, for example,irregular margin of the shallow mucosal depression, disproportionof the mucosal granularity, irregularity on the erythematouschange and discoloration are essential in order to detect muchmore cases with less malignant appearance.