北守 茂, 男澤 伸一, 北沢 俊治, 奥山 修兒, 斉藤 裕輔, 小原 剛, 柴田 好, 岡村 毅與志, 並木 正義

Shigeru KITAMORI, Shin-ichi OZAWA, Syunji KITAZAWA, Syuuji OKUYAMA, Yusuke SAITOU, Tuyoshi OBARA, Yoshimi SHIBATA, Kiyoshi OKAMURA, Masayoshi NAMIKI

旭川医科大学第三内科

The Third Department of Internal Medicine, Asahikawa Medical College

キーワード : Depth of invasion, Gastric cancer, Endoscopic ultrasonography

To obtain a more accurate diagnosis of the extent of gastric cancerous invasion using endoscopoic ultrasonography (EUS), we propose a new classification of EUS findings based on the changes in submucosa and proper muscle layer. The subjects were 50 patients who had undergone surgery in the past 4 years for gastric cancer. Thirty six cases of early gastric cancer (22 cases of depressed type, 14 cases of protruded type) and 14 cases of advanced cancer were studied.
Using this classification, we were able to diagnose the depth of invasion as being so far limited to the mucosa when its EUS finding showed a tapering pattern in the sm layer. We could also diagnose gastric cancer as early when its EUS finding in pm layer showed upward-thickened pattern. In this study, the total accuracy rate of the EUS diagnosis on vertical invasion of gastric cancer was 84% (42/50 cases). The tapering pattern in the sm layer and upward-thickened pattern in the pm layer were thought to be reflecting benign changes derived from fibrosis and ulceration.
Our classification of EUS findings based on the changes in two layers of the gastric wall is very useful to get high rate of the accuracy of the diagnosis on vertical invasions of gastric cancer.