Abstract

Studied cases of gastric cancer were 203 among 464 cases of gastrectomized stomach cancers for the past three years in our university hospital, to which it was possible to perform the detail analysis of endoscopic findings and biopsied specimen. As a rule, eight pieces of biopsy specimen have been taken from one lesion in this study. In order to evaluate the accuracy of reading of endoscopic findings or technical skill of biopsy, the ratio were calcurated dividing the number of biopsied specimen proved to be cancerous histolo-gically, by the number of the biopsied specimen which the examiner believed to be cancerous. The fallowing discussions will be made by this ratio. In other words, when the ratio is 100%, itmeans the excellency of technique or easy performance of the biopsy.1) Types of the stomach cancer When the lesion was protruded type of stomach cancer such as type I, IIa or Borrmann I, the ratio was almost close to 100%, wherever the biopsied specimens were taken. In type IIc, ratio was satisfac-tory (74.1%) when the biopsies were taken from the cancer of the lesion, however, the ratio was low (58.3%), when the biopsies were taken from the merginal area to dicide the extent of the lesion. In type III or type III+IIc, the ratio was 58.3% when the biopsy was taken from merginal area, and it was 20% in adjacent area. The ratio was 42.1% in average. In Borrmann II, the ratio was 80% when the specimens were obtained from the excavated area, however, it was 51.7% when obtained from the rand wall. In Borrmann III, the ratio was approximately 70% from the center of the lesion and further less in the merginal area. In Borrmann IV, the cancerous tissue could be taken from the ulcerated area and over all ratio was only 52.8%.2) Analysis to the location of the lesion The ratio was high in the cases, of which lesion located either in the anterior wall of stomach or along the lesser carvatur and low in the cases of which lesion located in posterior wall of stomach or around( the carclia. This may be clue to the difference of technical difficulties, because the former lesions can he observed in en-face view, on the contrary, the latter lesions were only seen in profil or requir the retrograde technique, which make the biopsy forceps more slippery.3) Size of the lesion It seems that the size of the lesion does not influencethe ratio significantly. Therefore the importance of biopsy for the minor gastric cancer should be stressed.4) Ratio in sequence biopsy Eight biopsiecl were taken from one lesion in sequence numbering No.l to No.8. The ratio to obtain cancerous tissue in No.1 specimenn was 66.7% and it became 88.4% in No. 1 to No. 3, 98.9% to No. 6, and 100% to No.8, respectively. Therefore it is important to perform biopsy at least 8 times to obtain 8 pieces of specimen.5) Analysis of errorneous biopsyThe following 4 major contributory factors should be listed.1) malfunction of the instrument2) the site of the lesion3) technical factor4) the type of the lesion