術前診断された微小胃癌および小胃癌の臨床細胞学的検討

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  • Clinico-cytological study on 31 cases of minute and small gastric cancers diagnosed before operation.

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A clinicocytological study was performed in 8 cases of minute gastric cancer <5 mm in diameter and 23 cases of small gastric cancer 5.1-10 mm in diameter. The diagnosis was made in all cases by histological examination of resected materials.<BR>1) 75% of the minute cancer cases were diagnosed correctly by gastric biopsy, and 25% by brushing cytology. Combining the two methods raised the accuracy to 87.5%. 82.6% of the cases of small gastric cancer were diagnosed correctly by gastric biopsy, and 47.8% by brushing cytology. Combining the two methods for small gastric cancer produced an accuracy rate of 82.6%.<BR>2) Four cases were negative or suspicious by biopsy but suspicious or positive by cytology, causing the clinician to perform a second biopsy, from which the correct diagnosis was made. 93.5% of the cases were eventually diagnosed correctly.<BR>3) The 17 cases in which cytology was not positive were investigated retrospectively. In all 17 cases, only a few cells were obtained by biopsy. The surface of the cancerous tumor had been covered by necrotic debris or non-neoplastic epithelium, the cellularity of cancer tissues facing the lumen had been very low, or brushing of the lesion was very difficult because of bleeding caused by prior biopsy. In some cases, a false negative result was due to difficulties in cytological diagnosis of well-diffrentiated carcinoma, as only a few cells with mild atypism were present, or carcinoma cells coexisted with atypical epithelial hyperplasia or benign atypical cells.

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