Abstract
PurposeClinical application of narrow band imaging facilitates diagnosis of esophageal neoplasia. However, no previous investigation has been conducted on magnifying endoscopy combined with narrow band imaging in detection of minimal superficial esophageal neoplasia, which is defined as neoplasia <10 mm in diameter. The aim of this retrospective study was to evaluate the usefulness of this combined technique in the differential diagnosis of minimal superficial esophageal neoplasia.MethodsBetween January 2005 and November 2011, 53 minimal superficial esophageal neoplasias in 40 patients were diagnosed by screening upper gastrointestinal endoscopy with narrow band imaging at our hospital. We investigated findings including brownish dots, brownish epithelium, and demarcation line of minimal superficial esophageal neoplasia diagnosed histopathologically as low-grade intraepithelial neoplasia, high-grade intraepithelial neoplasia, and squamous cell carcinoma.ResultsSignificantly more brownish dots (P < 0.05) and brownish epithelium (P < 0.005) were observed in intraepithelial papillary capillary loops in high-grade neoplasia compared with low-grade neoplasia. When minimal superficial esophageal neoplasia was diagnosed as high-grade intraepithelial neoplasia or squamous cell carcinoma, sensitivity, specificity, positive predictive value, and negative predictive value were 88.9, 42.9, 44.4, and 88.2 %, respectively, for brownish dots; 94.4, 51.4, 50.0, and 94.7 %, respectively, for brownish epithelium; and 66.7, 62.9, 48.0, and 78.6 %, respectively, for demarcation line.ConclusionsThe combined technique was useful in the differential diagnosis of minimal superficial esophageal neoplasia.
Highlights
Esophageal cancer is the sixth largest cause of cancerrelated death and has poor prognosis [1]
When minimal superficial esophageal neoplasia was diagnosed as high-grade intraepithelial neoplasia or squamous cell carcinoma, sensitivity, specificity, positive predictive value, and negative predictive value were 88.9, 42.9, 44.4, and 88.2 %, respectively, for brownish dots; 94.4, 51.4, 50.0, and 94.7 %, respectively, for brownish epithelium; and 66.7, 62.9, 48.0, and 78.6 %, respectively, for demarcation line
The combined technique was useful in the differential diagnosis of minimal superficial esophageal neoplasia
Summary
Esophageal cancer is the sixth largest cause of cancerrelated death and has poor prognosis [1]. Because of the low risk of lymph node metastasis in this type of cancer, endoscopic mucosal resection (EMR) has been established as a standard therapeutic approach for superficial esophageal squamous cell carcinoma (ESCC) within the lamina propria mucosa (LPM) [2,3,4,5,6]. Recent advances in endoscopic techniques for treating gastrointestinal tumor include endoscopic submucosal dissection, in which extensive lesions can be excised en bloc for ESCC. This technique has become prevalent for treating stomach and colon cancer [7,8,9,10]
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