Diagnosis of gastric cancer had been improved by recent progress ` in X-ray and endoscopic examination. The usefulness of biopsy under direct vision in confirming of gastric cancer was reported by many authors previously. But the positive rate of gastric biopsy under direct vision in gastric cancer is variable by types and sites of lesion, and sites and numbers of biopsy. We performed endoscopy and biopsy under direct vision with fibergastroscope (Machida FGS-B and Olympus GFB) during the period from Aug. 1, 1971 to Aug. 16,, 1975 in 2123 cases suspected having gastric diseases.
The purpose of this presentation is to evaluate the results of biopsy under direct vision in 395 cases which gastric cancer was confirmed pathologically.
The results were as follows:
1. Of total 395 cases with gastric cancer, 272 cases were male and 123 were female. The peak of age incidence was 6th decade. Among these, gastric cancer was confirmed with biopsy under direct vision in 361 cases (91. 4%). and in 34 cases gastric biopsy was negative and gastric cancer was confirmed with operation. Operation for diagnostic and/or therapeutic purpose underwent in 130 cases, among them 20 cases of early gastric cancer were found. The positive rates of the endoscopic biopsy according to the location of lesion were as follows: In cases with the lesion at the upper body it was 96.6%, at the antrum 94. 9%, at the angle 92.7%, at the prepylorus 92.5%, at the midbody 92.3%, at the lower body 89.2% and at the stoma of gastroenterostomy 53.3%. In cases with the lesion at the lesser curvature it was 94.2%, at the anterior wall 90.7%, at the posterior wall 89.5% and at the greater curvature 83, 3%. The accuracy of endoscopic biopsy was different in the ´cases with different type of gastric cancer. In the Borrmann type I and III the accuracy was higher but it was lower in the Borrmann type IV.
2. The total number of biopsy performed´ in total 395 cases was 1624 (about 4.´1 per case) and 1001 specimens (61.6%) were positive in cancer. The positive rates of the specimens in cancer according to the location of the lesion from which we took them were as follows: In specimens from the lesion at the antrum it was 68.5%, at the midbody 66. 7%, at the angle 65. 7%, at the upper body 63.0%, at the lower body 56.3%, at the prepylorus 50.0% and at the stoma of gastroenterostomy 26. 1%. In specimens from the lesion at the lesser curvature it was 65. 1% ´ at the anterior wall 62. 0%, at the posterior wall 61.8% and at the greater curvature 44. 3%.
3. Of total 395 cases with gastric cancer, 20 cases had early gastric cancer. Among these, type I (Japanese classification) was found in one case, II a in one, II c in 4, ILK in 3, II c+ IQ in8, and 111+11c in 3. The positive rate of biopsy was 100% in cases with early gastric cancer, type I , )I a and IQ + II c, 87.5% in type 11 c+ 111, 75% in II c and 66.7% in IQ. Four specimens out of 5 from case with early gastric cancer, type I , 3 out of 5 from type II a, 13 out of 22 from type Ii c, 4 out of 20, from 1, 23 out of 39 from II c+ 1ff and 8 out of 12 from 1II + IL c were positive in cancer.
4. The better results (over 90%) of endoscopic biopsy were obtained when four or more specimens were taken. So we advice to take at least four specimens: in each case to improve the positive rate of, gastric-biopsy.
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