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Differential diagnosis between benign gastric ulcer and depressed type early gastric cancer by an image processing method focusing on type iii



Differential diagnosis between benign gastric ulcer and depressed type early gastric cancer by an image processing method focusing on type iii



Stomach & Intestine 26(9): 1011-1018



Endoscopic diagnosis has been nearly perfected and diagnostic problems are rarely encountered in the great majority of patients. Nevertheless, there are occasions when cancer may be mistaken for an ulcer or an ulcer easily confused with a cancer. It was difficult to differentiate between the redness of regenerating mucosa at the edge of an ulcer and the redness of a cancer lesion using a conventinal fiberscope. But it is easy to distinguish between the regenerating mucosal pattern of an ulcer and the uneven punctate redness of a cancer with an electronic endoscope which provides a fine resolvable image. With this in mind, we attempted to differentiate between depressed-type early gastric cancer and benign gatric ulcer using an electronic endoscope (TGS-50B; Toshiba-Machida) and an image analyzer (SPICCA; Japan AVIONICS). We observed ulcerative lesions in detail with the electronic endoscope, and used the image analyzer to convert the redness surrounding the ulcer into binary digitized data. Next, the binary digitized pattern was separated into minimum units of gastric mucosal pits, an oval was postulated which possessed an inertial moment identical to each of the particles, and calculating its oval specification (OSF) value as the ratio of its long diameter to its short diameter, we used the average value of 20 particles as the image value. Evaluating the results of differential diagnosis of benign gastric ulcer and cancer-associated ulcer based on the OSF values obtained by image analysis gave the following results: (1) During the healing process, high OSF value in the entire periphery of the ulcer and a long, neat, string-like regenerating mucosal pattern indicate a benign ulcer. (2) The absence of a neat, string-like regenerating mucosal pattern in a portion of the margin of a gastric ulcer indicates that a malignant lesion should be suspected at that site.

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