Three hundred and sixty-five biopsies under direct vision, using a fibergastroscope, were performed on 339 patients with gastric cancer from 1966 to 1975. Diagnostic accuracy improved with an increased in the number of biopsy specimens and reached 100% when 6 or more biopsy specimens were obtained. Positive specimens were obtained with 48.5% of the biopsied tissue from the center of the lesion (A), 52.2% from the inner margin of the lesion (B1), 19.6% from the outer margin of the lesion (B2), and 1.6% from the area around the lesion (C). The combined result of the biopsies from A and B1 was highly positive in 49 out of 51 cases (96.1%). Diagnostic accuracy of the early cancer reached 96.9%. This was significantly higher than that of advanced cancer (80.3%). False negative biopsies were found in 51 (16.3%) of the 313 patients who were gastrectomized and diagnosed by histological examinations. Twenty-three of the 27 patients, who were diagnosed as benign either by x-ray or endoscopic examination, and 4 of the 5 patients who were diagnosed as benign under both examinations, were found to have positive results by biopsy. Positive biopsy examination was particularly helpful with patients showing on inconclusive or benign diagnosis by x-ray and/or endoscopic examinations.

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