Japanese

Endoscopic Diagnosis of Minute Cancers of the Esophagus Kumiko Momma 1 , Junko Fujiwara 1 , Hideto Egashira 2 , Naoto Egawa 2 , Tairo Ryotokuji 3 , Akinori Miura 3 , Tsuyoshi Kato 3 , Yousuke Izumi 3 , Yoko Tateishi 4 , Tetsuo Nemoto 4 , Misao Yoshida 5 1Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 2Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 3Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 4Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 5Foundation for Detection of Early Gastric Carcinoma, Tokyo Keyword: 食道微小癌 , 食道小癌 , 拾い上げ診断 , 深達度診断 pp.1749-1754
Published Date 2009/10/25
DOI https://doi.org/10.11477/mf.1403101783
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 Endoscopic surveillance by conventional observation and observation with the narrow band imaging(NBI)are recommended for detection of small and minute squamous cell carcinoma of the esophagus. When a small mucosal abnormality strongly suggestive of a cancer was identified in a conventional endoscopy, NBI observation is useful for further evaluation. A small cancer lesion is frequently identified as a brown area(BA)by NBI endoscopy. A magnify endoscopy allow us to observe intrapapillary capillary loops(IPCL)and to identify a small cancer lesion. The observation and classification of IPCL suggests a pathological grade of atypia. The margin of the lesion can be delineated as a brown area(BA)by NBI or as a blue area by toluidine blue staining. The depth of cancer invasion is an important issue in evaluation of a cancer lesion, for it suggests biological features of cancer lesion that must be considered in selection of treatments. Endoscopic estimation of depth of invasion in cases of type 0-IIc cancers is most important, for type 0-IIc lesions occupy 60% of all of small and minute cancers of the esophagus. IPCL in brown area should be studied in magnify endoscopy with NBI, for classification of IPCL strongly suggests depth of invasion. Endoscopic toluidine blue staining is also a useful measure in estimation of depth of invasion for a type 0-IIc lesion. When conventional, magnify endoscopy with NBI and toluidine blue staining strongly suggested a squamous cell carcinoma, histological studies should be carried out. An endoscopic mucosal resection(EMR)is recommended as the standard measure for a total biopsy of the small and minute lesion. If a bite biopsy was indicated, one biopsy should be obtained including part of the lesion and surrounding normal mucosa. An endoscopic surveillance with NBI on total esophageal mucosa must be carried out, for frequent synchronous multiple esophageal cancers(20%). Iodine staining at EMR must have the role of surveillance for synchronous esophageal cancers.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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