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Endoscopic Diagnosis of Cervical Esophageal Cancer Kumiko Momma 1 , Junko Fujiwara 1 , Akinori Miura 2 , Yuka Naganuma 1 , Toshihiro Matsui 2 , Kunihito Suzuki 2 , Tetsuma Chiba 2 , Shin-ichiro Horiguchi 3 , Tsunekazu Hishima 3 , Misao Yoshida 4 1Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 2Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 3Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 4Foundation for Detection of Early Gastric Carcinoma, Tokyo Keyword: 頸部食道癌 , 画像強調内視鏡 , 拾い上げ診断 , 内視鏡診断 pp.1715-1730
Published Date 2017/12/25
DOI https://doi.org/10.11477/mf.1403201245
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 We investigated 55 patients(46 males and 9 females)with 57 lesions of superficial cancer of the cervical esophagus between 2007 and 2016. Lesions of eight patients(14.0%)were detected at other hospitals, and 49 lesions in 47 patients(86.0%)were detected at our hospital(after endoscopic treatment of esophageal cancer, 36.8% ; after surgery of esophageal cancer, 26.3% ; synchronous cancer, 7.0% ; cancers of multiple organs, 10.5% ; and general examination, 5.3%). At our hospital, primary observation was conducted via endoscopic examination using white light during the insertion phase and NBI during the withdrawal phase. In this study, 6 of 13 lesions(46.2%)detected with white light during the insertion phase were T1a-MM or deeper cancer. Meanwhile, 17 of 21 lesions(81.0%)detected with NBI during the withdrawal phase were <15mm in size, and a majority of them invaded up to T1a-LPM. However, they included two lesions of T1b-SM cancer. Attachments were useful for detecting six lesions, including three lesions near the esophageal inlet.

 The long diameters of 57 lesions ranged from 2 to 43mm, and 80% of these lesions were within 20mm in size. The disease type included type 0-I in 2 lesions(3.5%), type 0-IIa and mixed-type 0-IIa in 10 lesions(17.5%), type 0-IIb in 7 lesions(12.3%), and type 0-IIc in 38 lesions(66.7%). The depth of invasion included T1a-EP cancer in 32 lesions(56.1%), T1a-LPM cancer in 12 lesions(21.1%), T1a-MM cancer in 7 lesions(12.3%), T1b-SM1 cancer in 2 lesions(3.5%), and T1b-SM2 cancer in 4 lesions(7.0%). Thus 77% of lesions invaded up to T1a-LPM. Three lesions, including one lesion of T1a-MM cancer and two lesions of T1b-SM2, were positive for vascular invasion, and one lesion of T1b-SM1 cancer was INFc.

 The efficient detection of superficial cancer of the cervical esophagus can be achieved by observation with NBI endoscopic examination using sedatives, primarily in patients with a history of esophageal cancer and multiple iodine-unstained lesions. In endoscopic observation of the cervical esophagus, the endoscope reaches the pharyngeal region, going through the esophageal inlet. When a sense of distance to lesions cannot be gauged, observation should be performed with the endoscope equipped with attachments, caps, hoods, etc.


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

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