5072 gastroscopies were performed in 3351 patients with a total of 14,554 biopsy specimens taken from 2565 lesions in the stomach. The endoscopic diagnoses and their histologic counterparts were recorded and the diagnostic yield of specimens from each type of lesion analyzed. Gastric adenocarcinoma was finally diagnosed in 139 patients. The diagnosis was delayed, from 1 to 4 months, in five patients because of false-negative diagnoses. These patients all had ulcerating cancers. Moreover, early gastric cancer was mainly of the ulcerating type. Accordingly, an ulcer lesion is the most important one to biopsy. Only four cancers were found in 959 benign-appearing gastritic lesions. Twenty-one patients with negative biopsy results at the first endoscopy were later shown to have cancer.
When these biopsy specimens were re-examined, malignant lymphoma was found in one and adenocarcinoma in three cases. In spite of false-negative endoscopic findings, nonrepresentative biopsy material and false-negative histologic reports, the combination of biopsy results and clinical judgement led to correct and timely treatment in nearly all patients.
Cancer 58:376-382, 1986.
HROUGH THE INTRODUCTION of upper gastrointes-
T tinal endoscopy, a new era was entered in the field of gastroenterology. The main advantage of this procedure versus routine radiologic examination is the much better possibility to detect minute lesions which will thus be biopsied directly. The importance of taking numerous biopsy specimens from gastric ulcers suspect of cancer, as well as the relative merits of gastric biopsies versus brush cytology, has been thoroughly in~estigated.'-~ However, to our knowledge the diagnostic yield of biopsy specimens taken from all sorts of gastric lesions has not been evaluated earlier.
It is well known that gastric cancers may appear as ulcers, erosions, polyps, or gastritis. Ideally, a number of biopsies should thus be taken from all gastric lesions as well as brush cytology. This would, however, result in an unfeasable large number of histologic and cytologic examinations which has to be weighed against their economic cost. Nevertheless, in the period 1974 through 1983, most gastric lesions found at endoscopy in our From the Departments of