Use of narrow-band imaging with magnification to predict depth of invasion of early esophageal squamous cell cancer and to guide endoscopic therapy

Abstract

A 77-year-old man undergoing EGD for Barrett’s surveillance was noted to have an area of discolored mucosa with mild nodularity in the upper esophagus. A biopsy sample taken from the lesion showed high-grade squamous dysplasia. Repeat endoscopy using narrow-band imaging (NBI) with magnification (GIF-HQ190 with integrated dual-focus magnification, Olympus Optical, Tokyo, Japan) showed a well-demarcated area with intraepithelial papillary capillary loop (IPCL) dilatation, elongation, and mild irregularity along with background color change (A). No neovascularization or avascular areas were noted. Lugol chromoendoscopy of this lesion did not stain. Based on the IPCL changes, we classified the lesion as type V2 per Inoue’s classification and type 3 per Arima’s classification. According to published data from Japan, both classes predict the cancer to be either