Abstract
ObjectiveThe aim of the present study was to clarify differences between micro-vascular and iodine-staining patterns in the vicinity of the tumor fronts of superficial esophageal squamous cell carcinomas (ESCCs).MethodsTen consecutive patients with ESCCs who were treated by endoscopic submucosal dissection (ESD) were enrolled. At the edge of the iodine-unstained area, we observed 183 sites in total using image-enhanced magnifying endoscopy. We classified the micro-vascular and iodine-staining patterns into three types: Type A, in which the line of vascular change matched the border of the iodine-unstained area; Type B, in which the border of the iodine-unstained area extended beyond the line of vascular change; Type C, in which the line of vascular change extended beyond the border of the iodine-unstained area. Then, by examining histopathological sections, we compared the diameter of intra-papillary capillary loops (IPCLs) in cancerous areas and normal squamous epithelium.ResultsWe investigated 160 sites that the adequate quality of pictures were obtained. There was no case in which the line of vascular change completely matched the whole circumference of the border of an iodine-unstained area. Among the 160 sites, type A was recognized at 76 sites (47.5%), type B at 79 sites (49.4%), and type C at 5 sites (3.1%). Histological examination showed that the mean diameter of the IPCLs in normal squamous epithelium was 16.2±3.7μm, whereas that of IPCLs in cancerous lesions was 21.0±4.4μm.ConclusionsThe development of iodine-unstained areas tends to precede any changes in the vascularity of the esophageal surface epithelium.
Highlights
For successful cure of esophageal squamous carcinoma (ESCC), detection at an early stage is essential
Histological examination showed that the mean diameter of the intra-papillary capillary loops (IPCLs) in normal squamous epithelium was 16.2±3.7μm, whereas that of IPCLs in cancerous lesions was 21.0±4.4μm
The development of iodine-unstained areas tends to precede any changes in the vascularity of the esophageal surface epithelium
Summary
For successful cure of esophageal squamous carcinoma (ESCC), detection at an early stage is essential. It has not been easy to diagnose early-stage ESCC using conventional endoscopy [1]. Chromoendoscopy using iodine-staining is a very sensitive screening technique, and has markedly improved the rate of early detection of ESCC [2],[3]. Several studies have demonstrated the usefulness of image-enhanced magnifying endoscopy for detection of early-stage ESCC, determination of the depth of cancer invasion, and assessment of the degree of cancer spread [5],[6]. Magnifying endoscopic observation of the normal esophageal mucosa and ESCC was first reported by Inoue et al [5],[7], who succeeded in recognizing looped capillary vessels inside the epithelial papillae (intra-papillary capillary loops: IPCL). The morphology of the surface vasculature of superficial ESCC exhibited characteristic changes according to the depth of tumor invasion
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