2019 Volume 34 Issue 3 Pages 450-457
Objective: The purpose of this study was to investigate the cause of overdiagnosis in gastric cancer screening, especially with respect to methods used in the double contrast study with barium meal.
Methods: From among 25,538 examinees who underwent upper GI series at Kansai Occupational Health Association, we selected 477 cases where precise examination by endoscopy was considered necessary. Of them, 26 cases were false positives, with no cancer endoscopically, despite malignancy being suspected radiographically. We applied a double contrast method using compression of the gastric antrum in addition to the standard gastric X-ray examination method recommended by the Japanese Society of Gastrointestinal Cancer Screening.
Results: False-positive results were most frequently produced by the initial X-ray examination. Deformation of the gastric angle due to scarring or submucosal tumor-like elevation may have provided the reason to suspect cancer. Inadequate X-ray photography often produces misleading results. Among reasons for inadequacy of radiography were problem lesion not being noticed during fluoroscopy, failure of barium adhesion to mucosal surface, defective image due to residual barium, apparent abnormality of normal mucosal folds due to method of compression, and inadequate skill in front wall photography.
Conclusions: To prevent false-positive results, in the X-ray study, we should use such measures as increasing the number of posture transformations, having examinees drink additional barium, appropriate removal of barium from the target site, improving front wall photography technique, adjusting amount of air in the stomach, and increasing reading ability so that lesions are noticed during fluoroscopic observation.
