This paper is to report the author's personal experience with the Gastrofiberscopes for Biopsy;, the Olympus GFB was mainly used and the Machida FGS-B₆ used in some cases. The materials consisted of 916 lesions in 671 cases from which 4041 pieces of tissue were obtained. 178 cases of advanced gastric carcinoma, 56 cases of early gastric carcinoma and 4 cases of gastric sarcoma examined during the period of May, 1965 through November, 1968 were included in this series. Most patients were examined in the out-patient clinic. No untoward side effects were noted except for. 1 case of melena, which, however, did not require any specific treatment. Pieces of tissue were first tapped on a slide glass to make smear specimen for cytological study. The tissues, threreaf ter, were fixed in 10% formaline for histological examination. The cytological specimens were stained with the Giemsa method and evaluated according to Papanicolaou's classification. The tissue specimens were mainly stained by Hematoxyline and Eosine, and PAS or Silver staine were used in selected cases. In regard to the results in relation to the macroscopic types of cancer, depressed type of early carcinoma was somewhat difficult, with the accuracy rate being 94.4% in the type II_c, 90.5% in the type II_c+III, and 66.7% in the type III+II_c. All of the cases of the other types were correctly diagnosed. In advanced cancer, the accuracy rates were 85.5%, 91.8%, 94.1% 94.4% and 100% in Borrmann type IV, II, III, Unclassified and Irespectively. No particular difficulty was encountered in small lesions, as long as the lesion was recognizable, and the results in smallerr lesions were evenn better. There were certain areas of the stomach which presented technical difficulty. Generally, the posterior wall of the pyloric antrum, the posterior wall of the body and the greater curvature of the body were difficult locations. Of the 4 cases of sarcoma, 1 case of leiomyosarcoma was misdiagnosed because there was no ulcerationn or fistula formation and the lesion covered by completely normal mucosa. Of 220 malignant lesions, 202 lesions were positive for malignancy both by histological and cytological study. In 4 casses, biopsy was positive, whereas cytological study of smears were reported negative. On the other hand, negative biopsy results were supplemented by positive cytological results in 9 cases. 5 cases were misdiagnosed both histologically and cytologically. It should be emphasized that cytological examination of smear of biopsied tissue is a useful adjunct to histological examination, because the tissue itself is benign but may carry malignant cells around it, or the necrotic tissue which is insufficient for pathological study may carry enough cells for cytological examination. In addition, procedure of this cytological examination is simple and gives the answer more quickly than hiastopathological examination. The combined result of biopsy and its smearr has resulted in correct diagnosis in 97.7% of the cases. Several pieces were taken from one lesion. Some pieces were negative. In early carcinoma of the type III+II_c, more than 6 pieces had to be biopsied to obtain cancer tissue, whereas the types II_c or II_c+III required the average of 3 pieces. The I, II_a and miscellaneous typees of early cancer needed 2 pieces. In advanced cancer, Borrmann type II was somewhat difficult, but generally 2 or 3 pieces were sufficient. Thus. the results were related, to certain amount, to the shape of the lesion and the nature of surface. The histopathologicall pattern of cancer tissue obtained by biopsy was compared with that of surgically resected specimen. It was then revealed that the biopsied specimens were ordinally large enough for diagnosis of subtypes of carcinnoma, and gave the clue, to the evaluatin of the extent of cellular atyism and structural atypism. 2488 pieces of tissue in

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This paper is to discuss the clinical aspects, endoscopic findings, gross findings of resected specimens, and pathohistological features of the so-called early carcinoma of the stomach with a reference to its surgical management. The material consisted of a total of 70 cases with 80 lesions encountered in our clinic and affiliated hospitals during the period of January, 1961 to December, 1967.I Clinical aspects. 1) The type II_c and the type II_c+III or II_c+ (III) were predominant, accounting for 27.1% and 31.4% respectively. 2) They were found most frequently in the fifth decade with the average age being 53.3 years old. The polypoid lesions, namely the type I and the type II a, tended to be encountered in higher ages in contrast to the type II_c and the type II_c+ III or II_c +(III). 3) The incidence of early gastric cancer was approximately 1.8% of all resectable gastric cancers after 1965. 4) Epigastralgia was the most frequent symptom being noted in 45.2% of the cases. However, 33.3% of the cases were asymtomatic. 5) The lesions were multiple in 11.4% of the cases. The tendency of multiplicity was particularly high in the types I and IIa. 6) Most of the lesions were situated in the antrum or the middle portion of the stomach. 7) Many lesions were less than 2cm in dimensions and there was a certain correlation between the size of the lesions and the depth of cancer infiltration. However, submucosal infiltration didd exsist in minute lesions less than 1cm in diamater. 8) Lymphnode metastasis was found in 8.3% and 13.3% in intramucosal cancers and those with subm ucosal infiltration respectively, with the average being 11.9%. Of three cases of the types I and II a with submucosal infiltration, two cases were found to be associated withh lymphnode matastasis. 9) All cases were adenocarcinoma.II Endoscopic diagnosis. 1) The type I and the type IIa. (1) In polypoid lesions, constriction of the neck, the size over 2cm, lobulated appearance andd extreme irregularity of the surface appeared to be significant indicators of malignancy. (2) Abnormalcy of the color seemed nonsignificant in diagnosis of malignancy of these types. (3) Polyps with atypical epithelium were difficult to differentiate from malignancy. 2) The type II_c, the type II_c+III and the type II_c+(III). (1) These types are similar to each other inn that the depressed surface with erosions are dominant. (2) Moth-eaten appearance is important. (3) The presence of radiating folds are indicative of the presence of III, and irregular thinning and/or abrupt ending of the folds along the margins of the depressed area are important features. Also significant is the occasional presence of islets withinn the lesions. (4) Variegated appearance in shape and color is important in these types. 3) The type III+II_c. Ulceration in this type is usually large, concealing the findings of depression(IIc) around it. Irregular thinning and/or abrupt ending of the converging folds should be carefully examined. 4) Miscellaneous types consisted of various combi-nations of the above mentioned types. Characteristics of each constituent type should be cautiously looked at.III Surgical considerations. 1) In the cases in which the macroscopic borde-rline is clear, resection 1cm apart from the lesion is usually sufficient. If, however, borderline is indistinct, operative cytology or frozen section is needed to decide the line of resection. 2) Lymphnode metastases were mostly confined to the primary nodes. Since, however, a secondary node involvement was found in one case, we would advocate dissection up to the secondary nodes.

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