Among about 500 cases of fiberscopies during the past two years from December, 1967 to November, 1969, the author experienced three cases of early stomach cancers and a case of superficial spreading stomach cancer with partial deep penetration, proved by surgery and histology. On all, repeated radiological, fiberscopic and cytological examination were done and the results of these examinations were summarized as follows:
1. Number of examinations by X-ray, fiberscopy and directed cytology on these four cases were 11, 12 and 11 respectively and the types of cancer were all of depressed type with or without some modification by elevated lesion.
2. By X-ray examination, correct diagnosis was done on no occasion out of 11 times of examination. The incorrect diagnosis consisted of 4 times of negative findings, 2 occasions of mucosal coarsening of antrum which was proved to be negative at surgery and 5 times of benign gastric ulcers.
3. Among 12 times of fiberscopic examinations, correct diagnosis was done on 11 occasions resulting in only one occasion of incorrect diagnosis which was in a first examination on a superficial spreading type of cancer with partial deep penetration.
4. Directed cytology under the fiberscopic observation was done on 11 occasions, one of which resulted in unsatisfactory sampling because of poor cooperation of the patient. Among the rest of 10 times of cytological examinations, typical (class Ⅴ) or probable cancer cells (class Ⅳ) were observed on 8 occasions (80.0%) and suspicious cancer cells (class }D) on 2 occasions. In all 4 cases, cytological examinations were repeated 2 to 4 times on each case and there were one or more chances of posicytology for each resulting in a 100% accuracy for correct diagnosis.
5. In conclusion, repeated examinations when the result of examination was not decisive appeared to be very important for correct diagnosis and the accuracy of fiberscopies with cytological examination would well be almost 100% even on cases of early stomach cancer.
|