Arai Junya, Yamada Hironori, Maruyama Masakazu
Foundation for Detection of Early Gastric Carcinoma, 2-6-12 Kayaba-cho, Nihonbashi, Chuo-ku, Tokyo 103-0025, Japan.
Gastric Cancer. 2002;5(1):35-42. doi: 10.1007/s101200200005.
The purpose of this study was to evaluate the capacity of detection (detectability), by radiographic examination, of minute gastric cancer that was indicated for endoscopic mucosal resection (EMR).
Fifty-five lesions in 55 patients with minute gastric cancer were endoscopically resected between 1992 and 2000 at the Foundation for Detection of Early Gastric Carcinoma. Of these 55 patients, 33 patients underwent indirect (with image intensifier and 100-mm roll film) and/or direct radiographic examination of the upper gastrointestinal tract as the initial screening examination, and subsequent upper gastrointestinal endoscopy. The remaining 22 patients underwent upper gastrointestinal endoscopy as the initial screening examination. As the first step, radiographic (indirect and direct) images were reviewed, and the abnormalities which had eventually led to the detection of the minute early gastric cancer (EGC) were reconfirmed. Then, they were analyzed in terms of the reproducibility of abnormal findings which enabled the detection of such a minute EGC, and in terms of whether they could be treated by EMR. The size, morphology, and location of the radiographically detected lesions were analyzed.
Seventeen lesions of EGC were detected in the group in which indirect radiography was initially performed. Of these 17 lesions, some abnormality corresponding to the site of the lesion was pointed out in 7 lesions (2 lesions of type IIa and 5 lesions of type IIc). On the other hand, the remaining 10 lesions (type IIa, 3; type IIc, 5; type IIa + IIc, 1; and type IIb, 1) were detected by endoscopy, which was carried out to confirm the other abnormalities in the indirect radiographic images. Sixteen lesions of EGC were detected in the group in which direct radiography was initially performed. Of these 16 lesions, some abnormality corresponding to the site of the lesion was pointed out in 8 lesions (4 lesions of type IIa and 4 lesions of type IIc). The remaining 8 lesions (3 lesions of type IIa and 5 lesions of type IIc) were not detected by direct radiography.
Indirect and direct radiographic examination enabled the detection of approximately 50% of EGCs which could be treated by endoscopic resection. The significance of radiographic examination should not be underestimated, even in the detection of EGCs which can be endoscopically resected.
本研究的目的是评估通过放射学检查对适合内镜黏膜切除术（EMR）的微小胃癌的检测能力（可检测性）。
1992年至2000年间，在早期胃癌检测基金会对55例微小胃癌患者的55个病变进行了内镜切除。在这55例患者中，33例患者接受了上消化道间接（使用影像增强器和100毫米卷筒胶片）和/或直接放射学检查作为初始筛查检查，随后进行了上消化道内镜检查。其余22例患者以上消化道内镜检查作为初始筛查检查。第一步，回顾放射学（间接和直接）图像，并再次确认最终导致检测到微小早期胃癌（EGC）的异常情况。然后，分析能够检测到这种微小EGC的异常发现的可重复性，以及它们是否可以通过EMR治疗。分析放射学检测到的病变的大小、形态和位置。
在最初进行间接放射学检查的组中检测到17例EGC病变。在这17个病变中，7个病变（2个IIa型病变和5个IIc型病变）指出了与病变部位相对应的一些异常。另一方面，其余10个病变（IIa型3个；IIc型5个；IIa + IIc型1个；IIb型1个）通过内镜检查检测到，该内镜检查是为了确认间接放射学图像中的其他异常。在最初进行直接放射学检查的组中检测到16例EGC病变。在这16个病变中，8个病变（4个IIa型病变和4个IIc型病变）指出了与病变部位相对应的一些异常。其余8个病变（3个IIa型病变和5个IIc型病变）未通过直接放射学检查检测到。
间接和直接放射学检查能够检测到约50%可通过内镜切除治疗的EGC。即使在检测可通过内镜切除的EGC时，放射学检查的意义也不应被低估。
