Diagnosis of Early Invasion Images of Esophageal Mucosal Cancer from the Viewpoint of Normal Endoscopy Miwako Arima 1 , Hideaki Arima 2 , Toko Yamada 1 , Mika Tsunomiya 1 , Isao Kikuchi 3 1Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan 2Arima Surgical-Gastrointestinal Clinic, Chiba, Japan 3Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan Keyword: 食道癌 , 食道LPM癌 , 初期浸潤像 , 内視鏡診断 , 拡大内視鏡診断 pp.1349-1358
Published Date 2012/8/25
DOI https://doi.org/10.11477/mf.1403113571
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 We examined endoscopic images from early invasion of 36lesions of T1a-LPM esophagus cancer. The degree of LPM invasion was evaluated as micro-invasion(slight invasion of the basal layer area), downward growth(invasion to the middle layer of LPM, and deep invasion(invasion to deeper parts of the LPM). Micro-invasion cannot be detected by normal endoscopy. Even with magnified observation, the invaded part often cannot be identified, but aggregation of avascular area-small(AVA-small)under 500μm was observed in 35% of lesions. With downward growth, AVA-small formation was observed more frequently on magnified observation, but fine white granules and discolored hyperplasia were recognized in only 20% of normal observations. In deep invasion, discolored granular eminence, hyperplasia surface, and coarse grained areas were recognized in all normal observations. In magnified observations, avascular area-middle(AVA-middle)less than 3mm consisting of non-looped irregular vessels(Japanese Classification of Esophageal Cancer Type B2)and Type B2 blood vessels were observed. When invasion progressed as the size of the tumor mass increased, the size of AVA surrounded by Type B2 blood vessels increased. However, we found that in lesions showing droplet infiltration, fine AVA consisting of Type B2 blood vessels was formed even at the micro-invasion level.

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