DIAGNOSIS OF GASTRIC-CARCINOMA - SENSITIVITY OF DOUBLE-CONTRAST BARIUM STUDIES

OBJECTIVE. This study was undertaken to determine if the double-contra st upper gastrointestinal examination is a sensitive technique for dia gnosing gastric carcinoma. MATERIALS AND METHODS. We retrospectively r eviewed the radiographs of 80 patients with pathologically proved gast ric carcinoma who had double-contrast barium studies of the upper gast rointestinal tract between 1985 and 1992. The original radiologic repo rts were also reviewed to determine if the lesions had been detected o n radiographic studies and if a diagnosis of gastric carcinoma had bee n made or suspected on the basis of the results. Subsequently, radiolo gic records were reviewed to identify all patients who had double-cont rast studies during a recent 1-year period for whom endoscopy was reco mmended for evaluation of possibly malignant lesions. Pathologic recor ds were also reviewed to determine the number of true-positive and fal se-positive cases in this group. RESULTS. The lesions were detected ra diographically in all 80 patients. In one case, however, the lesion ha d been missed on another barium study 2 years earlier, so that we actu ally detected 79 (99%) of the 80 gastric carcinomas. Malignant neoplas m was diagnosed or suspected in 77 cases (96%). In two of the three ca ses in which gastric carcinoma was not mentioned in the radiologic rep orts, the lesion caused gastric outlet obstruction. A separate 1-year retrospective review revealed that only 54 (3.5%) of 1546 patients who had double-contrast studies during this period were referred for endo scopy because of radiographic findings that were equivocal or suggesti ve of tumor. The presence of gastric carcinoma was confirmed by endosc opy or surgery in 10 (19%) of those 54 patients. CONCLUSION. Our findi ngs indicate that the double-contrast upper gastrointestinal examinati on is a sensitive technique for the diagnosis of gastric carcinoma. Fu rthermore, a high sensitivity can be achieved without having an inordi nate number of patients undergo unnecessary endoscopy.