Endoscopic Evaluation of Depth of invasion in Superficial Esophageal Cancer by Conventional Endoscopy and Chromoendoscopy Kumiko Momma 1 , Misao Yoshida 2 , Junko Fujiwara 1 , Hideto Egashira 3 , Naoto Egawa 3 , Tairo Ryotokuji 4 , Akinori Miura 4 , Tsuyoshi Katoh 4 , Yousuke Izumi 4 , Yoko Tateishi 5 1Department of Endoscopy, Tokyo Metoropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 2Foundation for Detection of Early Gastric Carcinoma, Tokyo 3Department of Gastroenterology, Tokyo Metoropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 4Department of Surgery, Tokyo Metoropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 5Department of Pathology, Tokyo Metoropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo Keyword: 食道表在癌 , 深達度診断 , 通常観察 , 色素内視鏡 , 内視鏡治療 pp.650-663
Published Date 2011/5/24
DOI https://doi.org/10.11477/mf.1403102225
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 One of the goals of the endoscopic evaluation of superficial esophageal cancer is to estimate depth of cancer invasion and classify them into three categories such as a)group A : superficial esophageal cancer with invasion of T1a-EP and T1a-LPM, that rarely has lymph node metastasis, b)group B : T1a-MM and T1b-SM1 with low incidence of lymph node metastasis and c)group C : T1b-SM2 and T1b-SM3, with frequent lymph node metastasis. Any local treatment that can eradicate cancer lesion provides radical treatment for group A. In cases with group B, most patients in this category can be cured by local treatment, but a small number of patients have lymph node metastasis and require additional treatment. Radical esophagectomy is recommended for group C.

 In cases with elevated cancer lesions, endoscopic analysis on size, height, irregularity and color of the elevation, and shape of the base of lesion are points of diagnosis for estimation of depth of cancer invasion. In cases with superficial cancer with depression, grade of step down, irregularities in the depression and elevation close to the margin of depression help endoscopic estimation of depth of invasion. Dark blue staining by toluidine blue, interruption of fine transvers mucosal folds strongly suggest sites with deeper invasion. Magnify observation with narrow band imaging(NBI)allow us to detect micro-vascular abnormalities that are strongly suggestive of narrow and deeper invasion.

 In order to clarify the accuracy of endoscopic evaluation of depth of cancer invasion, clinical and pathological diagnoses on 296 superficial cancer lesions in 247 patients were reviewed. Type 0-IIb lesion occupied 26%of all lesions, type 0-IIc 65%, type 0-IIa 6%and type 0-I 3%.

 Depth of cancer invasion was correctly estimated by endoscopic studies in 89% of all lesions : 95% in T1a-EP and T1a-LPM, while 66% in T1a-MM and T1b-SM1 and 61% in T1b-SM2 or more.

 In cases with T1a-EP and T1a-LPM, 92% of all lesions were type 0-IIc(61%)and type 0-IIb(31%). At the same time, type 0-IIc lesions were noted in 88.5% of all T1a-MM and T1b-SM1 lesions. In cases with T1b-SM2 and T1b-SM3, type 0-IIc lesions occupied 67% of all lesions and type 0-I 28%. Type 0-IIc lesions occupied 84% of all lesions with invasion of T1a-MM or more that failed in endoscopic estimation of depth of invasion. In cases with T1a-MM and T1b-SM1, micro-invasion was frequent among type 0-IIc lesions underestimated in depth of invasion(71%)while T1b-SM2 50%.

 Conventional endoscopy aide by chromoendoscopy,NBI and magnify observation can detect deeper invasion of width 1.8mm or more.

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