Abstract
In order to make clear the problems pertaining to the estimation of vertical invasion in the recent cases of depressed type of early gastric carcinoma, endoscopic pictures of 489 patients with solitary lesion were reviewed and the results were compared chronologically. The 489 patients underwent gastrectomy during the period from 1972 to 1980 and they included 367 of early carcinoma (m:199, sm:168) and 122 of IIc-like advanced carcinoma. According to the convetional diagnostic criteria, endoscopic findings in these lesions were evaluated on the following four parts of the cancerous lesions ; converging folds (F), depressed area (D), elevated component of the marginal area (E) and stiffness of gastric wall arround the lesion (S). To quantify the endoscopic malignancy, we gave marks to the finding in the four parts, respectively, that is to say, point-0 (underectable of malignant finding), point-1 (detectable of only superficial malignant finding), point-2 (in addition to point-1, detectable of conventional submucosal invasive finding) and point-3 (detectable of much more advanced finding). The points obtained from each of the four parts were summed up in each case and we treated this total point as the malignant score in endoscopic appearance. The results obtained were as follows : 1. Score-distribution of the subjects showed that the malignant score was closely related to the degree of vertical invasion. And according to their scores obtained, endoscopic appearance of the subjects could be classified into following three groups ; "low score group", whose score ranged from 0 to 1, "middle score group" from 2 to 4, and "high score group" more than 5. In low score group 73% were musosal and 26% submucosal carcinomas. In middle score group, 46% were mucosal, 41% submucosal and the rest 13% advanced carcinomas. In high score group, only 7% were mucosal, 27% submucosal andthe rest 66% advanced carcinomas. 2. Comparing the malignant score of early cancer by every three years, low score group had been markedly increasing (16 to 38%) and high score group decreasing (19 to 7%) in the last three years. In advanced cancers, however, no such chronological trend was observed in the period of nine years. 3. In the early cancer detected during the last three years, conventional diagnostic criteria for estimation of vertical invasion were quite less frequently observed endoscopically, especially on the tip of converging folds (F), surrounding area (E) and gastric wall arround the lesion (S). Only the mucosal pattern of cancerous depression, however, showed different score-distribution between mucosal and submucosal carcinomas. That is to say, most (over 70%) of the cases whose point on that area was 0 or 1 were mucosal and those of 2 or 3 mostly (over 70%) submucosal carcinomas.
