Diagnostic accuracy of fiberendoscopy in the detection of upper intestinal malignancy. A follow-up analysis.

The accuracy of fiberendoscopy with directed biopsy in the detection of upper intestinal malignancies has been evaluated by studying the operative or postmortem findings or the clinical follow-up data after at least 1 year and, for relevant lesions, after 2 or 3 years. Of 1005 patients examined, a satisfactory follow-up was obtained in 990. There turned out to be no false-positive diagnoses of malignancy in the 167 patients diagnosed fiberendoscopically to harbor an upper intestinal malignancy, and only two false-negative diagnoses in the fiberendoscopically benign group. Seven of the 135 adenocarcinomas of the stomach turned out to be early gastric cancers. The two missed malignancies were interpreted initially as benign gastric ulcers. The over-all endoscopic-bioptic accuracy rate calculated for all patients amounts to 99.8%. Such a high accuracy rate can only be reached provided high numbers of biopsies are taken, and particularly at least 10 of gastric ulcers and of suspicious lesions. Endoscopy by itself is not sufficiently reliable in determining the nature of the lesion. Indeed an incorrect endoscopic interpretation was made in 7.3% of the ulcerous lesions, and in 8.2% of them no firm conclusion could be reached.