Endoscopic Estimation of Depth of Invasion in Cases with Superficial Cancer of the Esophagus Kumiko Momma 1 , Misao Yoshida 2 , Junko Fujiwara 1 , Hideto Egashira 3 , Naoto Egawa 3 , Akinori Miura 4 , Tsuyoshi Kato 4 , Yousuke Izumi 4 , Tetsuo Nemoto 5 , Nobuaki Funada 5 1Department of Endoscopy, Tokyo Metropolitan Komagome Hospital, Tokyo 2Ebara Hospital, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo 3Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 4Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo 5Department of Pathology, Tokyo Metropolitan Komagome Hospital, Tokyo Keyword: 食道表在癌 , 深達度診断 , 内視鏡病型分類 , 拡大内視鏡観察 , NBI観察 pp.673-682
Published Date 2007/4/26
DOI https://doi.org/10.11477/mf.1403101065
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 Estimation of cancer invasion into the esophageal wall is one of important issues in endoscopic diagnosis on superficial esophageal cancer. The depth of invasion has a close relationship with histological findings of micro vascular invasion and lymph node metastasis that we have to consider in selection of treatment. It is recommended that superficial esophageal cancers should be differentiated into three categories such as group-1: T1a-EP and T1a-LPM cancers for which localized treatments such as EMR are recommended, group-2: T1a-MM and SM1cancers that give a relatively high indication for EMR, because of low incidence of lymph node metastasis(10%)and group-3: SM2and SM3cancers that probably have lymph node metastasis in30~50%, so radical esophagectomy should be employed. Generally speaking, mucosal cancers show less irregularity while those with deeper invasion frequently present distinct elevation or depression, such as type0-I and type0-III lesions which represent submucosal cancer while type0-II indicates mucosal cancer. Mucosal cancers are frequent among type0-IIa and type0-IIb lesions. At the same time, type0-IIc lesions include mucosal cancers and some SM2and SM3cancers.

 Endoscopic findings strongly suggesting deeper invasion are partial and distinct elevation or depression, persistent deformities despite extension of the esophageal wall, interruption of longitudinal folds or interruption of vertical mucosal folds, discrepancies of movement of the tumor and the muscle layer on peristalsis, abnormal findings of capillaries on magnifying observation and dark blue staining with endoscopic toluidine blue-iodine double staining. Magnifying endoscopy provided us with a new means for the estimation of cancer invasion : deeper invasion should be suspected when there is evidence of abnormalities in size and distribution of capillaries, and abnormal vessels suggesting stromal vessels of the tumor. A part of the cancer lesion that lacks in capillaries and is surrounded by abnormal and long vessels strongly suggests invasion into the muscularis mucosae or more(avascular area : AVA). The size of AVA also allows us to estimate the grade of deeper invasion. We have keep in mind the fact that cancer infiltration covered by normal mucosa or intraepitherial cancer probably show no abnormal findings on endoscopic observation.

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