Endoscopic Study of Differential Diagnosis between Benign Ulcers and Malignancies with Open Ulcers of the Stomach

Abstract

To clarify the problems of endoscopic diagnosis for gastric lesions with open ulcer, we assessed the endoscopic appearance of the discrepant cases between the first endoscopic diagnosis and histopathological diagnosis. There were 550 cases which had gastric lesions with open ulcer, excluding non-epithelial tumors and received endoscopic biopsies between July 1992 and July 1995 at National Cancer Center Hospital East.
Twenty cases of those were discrepant between the first endoscopic diagnosis and histopathological diagnosis, in which 6 cases (2.0%) were false positive and 14 (5.6%) false negative. Five of 6 false positive cases were diagnosed as advanced cancer and 8 of 14 false negative cases as IIc＋III at the first endoscopic examination. In the second look diagnosis, 3 of 6 false positive cases and 8 of 14 false negative cases were diagnosed correctly. However, 3 of false positive cases could not be diagnosed even in the second look diagnosis because of showing irregularity of the ulcer margin, thinning and step-down of converging folds, or multiple ulcers with various erosions and redness. In addition, 6 of false negative cases could not be diagnosed correctly in the second look diagnosis, because one located in the prepylorus could not be observed thoroughly and the other 5 lacked malignant findings endoscopically. It was thought that the differential diagnosis was difficult endoscopically between benign ulcers and malignancies with open ulcer of the stomach in a total of 9 cases (1.6%) .
These results suggest that careful observation combined with dye spraying method and re-examination after follow-up by anti-ulcer therapy are necessary for gastric lesions with open ulcer.