Diagnosis of Early Squamous Cell Carcinoma of the Esophagus, Using High-resolution Endoscopy Yuichi Shimizu 1 , Takeshi Yoshida 1 , Mototsugu Kato 2 , Rumiko Asaka 1 , Urara Nishida 1 , Keiko Yamamoto 1 , Aki Imai 1 , Jojo Hirota 1 , Manabu Nakagawa 2 , Shoko Ono 2 , Masahiro Asaka 1 1Third Department of Internal Medicine, Hokkaido University School of Medicine, Sapporo, Japan 2Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan Keyword: 早期食道癌 , 内視鏡診断 , ヨード染色 , 上皮内癌 , high grade intraepithelial neoplasia pp.1422-1430
Published Date 2008/9/25
DOI https://doi.org/10.11477/mf.1403101465
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 Despite the recent progress in endoscopic diagnostic modalities such as magnifying endoscopy and narrow band imaging, the findings obtained by ordinary endoscopic examination with white light are still the most important. The important mucosal findings of early squamous cell carcinoma of the esophagus are slight redness, disorder of the minute vessels, slight unevenness and slight whiteness. The ability to detect early squamous neoplasia of the esophagus can be enhanced considerably by iodine staining during endoscopic examination. Endoscopic examination with iodine staining for patients with mucosal findings by conventional endoscopy or in high-risk populations is still recommended in order to detect early squamous lesions of the esophagus. The normal epithelium is stained by iodine, which interacts with glycogen present in the tissue. Carcinomas containing no glycogen remain unstained and are thus clearly demarcated from the surrounding normal mucosa. According to the WHO classification, intraepithelial sqamous neoplasia is graded as high-grade when both architectural and cytological abnormalities occur in the upper half of the epithelium, so high grade intraepithelial sqamous neoplasia will be observed as an iodine unstained area with a pink color. The pink color sign is useful especially in patients with esophageal mucosa showing many minute iodine-unstained areas.

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