胃癌診断に関する臨床細胞学的研究

直視下採取法および剥離癌細胞の形態学的特徴について

抄録

[A] Three methods are used at present in direct vision cytology; the lavage method, the suction method, and contact smear of biopsy tissue. This paper is to discuss the clinical value of these techniques with special reference to the suction method.
The instrument used for suctioh method is the Model B fiberscope (fiberscope for biopsy), with which a thin Teflon tube with a beveled metal tip instead of the biopsy forceps is introduced into the stomach and advanced, under direct vision, to the given target. Repeated negative pressure using a 100 ml syringe is then applied to suck material into the tube. The material is then flushed and smeared on a slide glass.
This method is characterized by the following,
1. Preliminary lavage is not necessary.
2. Abundant fresh cells can be obtained with minimal necrotic debris.
3. Multiple lesions can be examined simply by changing the tube.
4. The damage given to the tissue is least in comparison with the lavage method or biopsy. This method is, therefore, particularly suitable for minute lesions, but is difficult to obtain material from deeper portions.
5. The suction method has given correct diagnosis in 97% of the cases, that is comparable to the other methods. The method thus suffices clinical purposes, but the result will be further improved if these techniques are combind acording to the location or morphological characteristics of the lesion to be examined.
[B] By the morphological analysis of exfoliated cells of gastric cancer, by examining the touch smear specimen of the biopsy tissue, the following results were obtained.
The general features of the tumor cells of early gastric carcinoma, in comparison with those of advanced gastric carcinoma, were as follows.
1. The tumor cells of early gastric carcinoma had poor anisocytosis, and were smaller in size.
2. Chromatin was thin and poor in early carcinoma cells.
3. Nucleoli were smaller in early carcinoma cells.
4. In advanced gastric carcinoma mitosis was found more frequently than in early carcinoma.
5. Glandular formations were seen more ofen in early carcinoma specimen.
Accordingly, in the aspect of clinical cytology, the exfolliated cells of early gastric carcinoma have lower malignant signs than these of advanced gastric carcinoma.