Evaluation of fine-needle aspiration biopsy under direct vision gastrofiberscopy in diagnosis of diffusely infiltrative carcinoma of the stomach.

The accuracy of diagnosis of diffusely infiltrative carcinoma of the stomach by direct endoscopic biopsy and cytologic examination were examined. A histologic diagnosis was made in 54 (83.1%) and a cytologic diagnosis in 49 (75.4%) of 65 patients. By combined histologic and cytologic examinations, the overall diagnostic rate was raised to 87.7%. False-negative results were most frequent for tumors without erosions or shallow ulcerations. Positive diagnoses from histologic examination were usually obtained from erosions or ulcerations rather than from normal-appearing mucosa. These findings indicate that endoscopic detection of erosion or ulceration and subsequent biopsy are important for the diagnosis of diffusely infiltrative carcinomas. The authors developed a procedure for heparinized fine-needle aspiration biopsy under direct vision with a gastrofiberscope. In this procedure, heparinization of the needle and injector prevented blood coagulation. This made it possible to obtain good smears containing less degenerated tumor cells, and to obtain histologic materials. By this method, a correct cytologic diagnosis was made in all 11 patients examined. Histologic material was obtained from four patients in whom histologic and cytologic information on cancer could not be obtained by routine endoscopic examination.