Abstract
In order to clarify the diagnostic limitation for the extent of cancer cell infiltration in depressed early gastric cancer, 21 cases of early depressed gastric cancer on lesser curvature of gastric body were studied using electronic endoscopy. The endoscopically suspicious gastric cancer area of each case was marked off from surrounded normal mucosa with metal clips to be compared with immediate pathological diagnosis in resected specimen. Then, the inconsistency between endoscopic and pathological diagnosis was evaluated. Endoscopic diagnosis of cancer area in 12 (57%) cases corresponded to those of pathological findings, but not in 9 (43%) cases. The predominant gross type in correctly diagnosed cases was IIc (75%), and in incorrectly diagnosed cases was IIb (56%). Endoscopic features, such as discoloration, abnormal pattern of gastric area, disappearance of vascular pattern and well-defined depressed margin from surrounded mucosa were seen in correctly diagnosed cases. These 4 endoscopic features were less seen in the incorrectly diagnosed cases. Pathologically all layer mucosal infiltration with undifferentiated adenocarcinoma was observed in 7 of 12 correctly diagnosed cases (58%) and 4 of 9 incorrectly diagnosed cases (44%). Middle mucosal layer infiltration was noticed in 3 of 12 correct cases (25%) and 4 of 9 incorrect cases (44%). These results suggested that there was the limitation of present electronic endoscopic diagnosis for the extent of infiltration in depressed early gastric cancer, even if we made a careful examination with 4 diagnostic features mentioned everywhere. However, if discoloration and disappearance of vascular pattern could be seen in the IIb cases with middle layer infiltration of undifferentiated adenocarcinoma by image processing, accuracy of diagnosis might be improved. Therefore, the further development of new image processing electronic endoscopy is required in the future.
