Magnifying Endoscopy with FICE for the Screening and Differential Diagnosis of Small Squamous Cell Carcinomas of the Esophagus Miwako Arima 1 , Hideaki Arima 2 , Masahiro Tada 1 1Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan 2Arima Surgical-Gastrointestinal Clinic, Chiba, Japan Keyword: 拡大内視鏡 , 食道小癌 , 微細血管分類 , FICE pp.1675-1687
Published Date 2009/10/25
DOI https://doi.org/10.11477/mf.1403101776
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 We examined whether magnifying endoscopy is useful for the screening, differential diagnosis, and treatment of small squamous cell carcinomas of the esophagus. A total of 183 lesions(85 small lesions, 69 micro lesions, and 29 supermicro lesions)10 mm or less in diameter that arose in the squamous cell epithelium of the esophagus were studied. Of all small lesions, 54% were detected on conventional endoscopy, and 46% were detected under iodine staining. Many supermicro lesions detected on endoscopy were associated with marked vascular changes. Lesions recognized as a brownish area on image enhanced endoscopy with Fujinon intelligent color enhancement(FICE)could be detected on conventional endoscopy. Magnifying endoscopy with FICE facilitated the assessment of vascular patterns, thereby contributing to improved diagnostic accuracy. On magnifying endoscopy, 83% of lesions with type 1 and 2 microvascular patterns were judged to be inflammation or with no evidence of atypia, and 87% of lesions with type 3 and 4 microvascular patterns were squamous cell carcinomas. Low grade intraepithelial neoplasia was associated with various vascular changes and was difficult to diagnose on the basis of microvascular patterns. A very high proportion of small lesions(98%)could be differentially diagnosed as benign or malignant lesions, suggesting that EMR could be performed without biopsy. Lesions with type 4 vessels may invade the muscularis mucosae or submucosa and should therefore be examined in detail. Many supermicro lesions and micro lesions are difficult to diagnose qualitatively on the basis of vascular patterns. Biopsy is therefore required for a definite diagnosis. Clinically, however, we believe that curative treatment is possible if lesions are resected when they show slight enlargement or distinct changes in vascular patterns.

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