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NBI Magnifying Endoscopic Diagnosis for Superficial Esophageal Cancer Haruhiro Inoue 1 , Tomoyuki Ishigaki 1 , Masashi Misawa 1 , Haruo Ikeda 1 , Makoto Kaga 1 , Hitomi Minami 1 , Yoshitaka Sato 1 , Shigeharu Hamatani 2 , Shin-ei Kudo 1 1Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan 2Department of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan Keyword: NBI , 拡大内視鏡 , IPCLパターン分類 , ECA分類 , 深達度診断 pp.664-675
Published Date 2011/5/24
DOI https://doi.org/10.11477/mf.1403102226
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 In the esophagus there seems to be nothing equal to pit pattern in the glandular epithelium as an index of structural atypia of the tissue. During magnifying observation we pay attention to IPCL(intra-epithelial papillary capillary loop)as a marker for tissue structural atypia. It is considered that the IPCL changes relate to tissue atypia of the para-basal layer/basal layer. IPCL type classification is expected to be not only a marker of tissue atypia but a marker of invasion depth. IPCL type V-1 in magnifying endoscopy is diagnosed as carcinoma in situ with a tetrad of dilatation, tortuosity, caliber variation, configuration heterogeneity in IPCL. IPCL type V-2,V-3 demonstrates a breakdown of IPCL according to tumor progression. IPCL type VN includes findings that are characteristic of deep sm part infiltration of the cancer. It is supposed that real cancer invasion is in accord with the magnifying endoscopic findings to an equal level or to the deeper layer.

 IPCL type V-3 is subdivided into two major categories. V-3A corresponds to abnormal vessels which run in a horizontal plane. This abnormal vessel is never seen in non-neoplastic epithelium. V-3A. V-3A related invasion depth M2 deep in 50% and M3SM1 in another 50%. V-3B has an abnormal vessel which expands into the deeper histological layer(vertical invasion). V-3B corresponds to M3SM1 in 73% and SM2 in 24% of cases.

 High-resolution endoscopy with NBI magnifying function allows us to detect even minute neoplastic lesions. As a diagnostic process, detection of a brown spot or brownish area is the first step in the detection of such lesions. At the second step, magnifying endoscopy is carried out using NBI magnification. IPCL patterns which reflect structural atypia of the epithelium can be classified into five categories. IPCL type classification can be significantly applied to a flat lesion as endoscopic diagnosis of the tissue atypia. IPCL type IV and V lesions are well treated by EMR/ESD. Magnifying observation has already been enrolled as a part of regular endoscopic observation.

 Ultra-high magnification endoscopy using endocytoscopy facilitates the observation of cell-level structures in vivo. Endocytoscopic findings are classified into five categories of ECA(endocytoscopic atypia)classification. This endocytoscopic image may be regarded as the third step in diagnosing tissue atypia.


Copyright © 2011, Igaku-Shoin Ltd. All rights reserved.

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

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