Japanese

Endoscopic and Pathological Studies on Type B2 Blood Vessels in Estimation of Invasion Depth of Superficial Esophageal Cancer Junko Fujiwara 1 , Kumiko Momma 1 , Yoko Tateishi 2,3 , Tomoko Nagao 4 , Yuka Kowazaki 4,5 , Akinori Miura 6 , Tsuyoshi Katoh 6 , Yousuke Izumi 6 , Tsunekazu Hishima 2 , Misao Yoshida 7 1Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 2Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 3Department of Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan 4Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 5Department of Internal Medicine, Tokyo Metropolitan Matsuzawa Hospital, Tokyo 6Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 7Foundation for Detection of Early Gastric Carcinoma, Tokyo Keyword: 食道表在癌 , 拡大内視鏡 , 深達度診断 , 日本食道学会分類 , B2血管 pp.174-185
Published Date 2014/2/25
DOI https://doi.org/10.11477/mf.1403114071
  • Abstract
  • Look Inside
  • Reference
  • Cited by

 In order to clarify the effectiveness of endoscopic observation of blood vessels using NBI(narrow band imaging)and magnifying endoscopy, 241 superficial esophageal cancer lesions were studied. All lesions were treated by ESD(endoscopic submucosal dissection)or EMR(endoscopic mucosal resection)from January 2011 to July 2013. The endoscopic classification of blood vessels(by the Japan Esophageal Society 2012)was employed. Accuracy of endoscopic estimation of invasion depth was attested by histological studies on resected specimens.

 Invasion depth was correctly estimated in 95%(163/171)of T1a-EP/LPM cancer cases, 61.7%(21/34)in T1a-MM/T1b-SM1, and 66.6%(10/15)in T1b-SM2 or deeper. In cases with 97 cancer lesions endoscopic estimation of depth of invasion was carried out on the day of treatment. The sensitivity and specificity for depth of invasion were as follows : type B1 blood vessels ; 82%/95%, type B2 ; 86%/53%, and type B3 ; 25%/100%, respectively. Problem was the low specificity for B2 blood vessels. Histopathological images of B2 blood vessels were examined on 24 lesions. Histopathological images of B2 blood vessels could be classified into 4 types :(1)pattern a ; blood vessels that run across the interstitial tissue between the tumor nests,(2)pattern b ; blood vessels that surround the bulky tumor nodule,(3)pattern c ; blood vessels found in polypoid lesions with papillary growth, and(4)pattern d ; blood vessels with inflammation developing around ulceration and regenerative repair. This resulted in the low specificity for B2 blood vessels in the diagnosis of T1a-MM/T1b-SM1 cancers.

 In type 0-IIc and 0-IIa lesions, type B2 blood vessels in the thickened part of the lesion strongly suggested cancer invasion of T1a-MM deep or T1b-SM1, excluding type B2 blood vessels in regenerative changes after ulceration. However, type B2 vessels may remain in the shallow layer 100μm from the surface of the mucosa while part of cancer infiltration reached T1a-MM or more, making it difficult to obtain correct estimation of invasion depth using magnifying endoscopy alone. When discrepancies in invasion depth are found between conventional and magnifying endoscopy, endoscopic ultrasound is recommended to obtain correct estimation of cancer invasion.


Copyright © 2014, Igaku-Shoin Ltd. All rights reserved.

基本情報

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

関連文献

もっと見る

文献を共有