Accuracy of Roentgen Diagnosis of Benign Gastric Ulcer

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Abstract
RADIOLOGISTS, surgeons, and clinicians have found through experience that a certain number of gastric lesions diagnosed by roentgenologic methods as benign gastric ulcer have later proved to be carcinomatous. In the medical literature this diagnostic error is quoted as being from 5 to 20 per cent. From the maze of published material concerning benign gastric ulcer and its relationship to gastric carcinoma, a few conservative opinions may be gathered, although many of these will be argued pro and con until further study clarifies the whole cancer question. Briefly, the points of view expressed in the literature might be summarized as follows: 1. Nomenclature: Due to differences in course, prognosis, treatment, and possibly etiology, benign gastric ulcer and duodenal ulcer should be classified separately and not grouped as “peptic ulcers.” 2. Etiology: Numerous theories have been advanced for the etiology of both gastric ulcer and gastric carcinoma, but the question still remains open. 3. Incidence of Gastric Carcinoma: According to the best available figures, approximately 40,000 people die annually in the United States from gastric carcinoma. 4. Incidence of Malignant Transformation in Benign Gastric Ulcer: Figures can be quoted from the literature to show (a) that cancer rarely, if ever, develops in benign gastric ulcer, (b) that it may occur in a few cases, or (c) that it occurs in as high as 90 per cent of the cases. Probably the figures of Stewart are most widely accepted. According to these, 9.5 per cent of cases of chronic gastric ulcer become carcinomatous and 17 per cent of gastric carcinomas originate in chronic ulcers. However, several prominent radiologists are of the opinion that gastric carcinoma does not develop from benign gastric ulcer. 5. Symptomatology: There is no single symptom or group of symptoms that can be relied upon to differentiate the benign gastric ulcer from the malignant gastric ulcer. 6. Age and Sex: Although in a large series of cases the average age for patients with gastric carcinoma will be slightly higher than for those with benign gastric ulcer, this observation is of little value as applied to the individual case. Sex is of no significance in differential diagnosis. 7. Clinical Laboratory Tests: At this time there are no laboratory tests which will differentiate between gastric carcinoma and gastric ulcer. The single exception to this statement is the identification of a piece of tumor tissue obtained by gastric lavage, and clinical pathologists are now attempting to diagnose carcinoma of the stomach on the basis of single cells thus obtained. This test is related to Papanicolaou‘s work on the cytological diagnosis of cancer of the cervix and uterus. Many difficulties can be expected.

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