Early Cancer Lesions Research Articles

Narrow Band Imaging Technology: Role in the Detection of Recurrent Laryngeal and Hypopharyngeal Cancers Post-radiotherapy.

To assess the diagnostic accuracy of NBI endoscopy for the diagnosis of early recurrent laryngeal and hypopharyngeal cancers after radiotherapy. The study was conducted over a period of two and a half years from June 2019 to February 2022 and included 123 post-RT patients with laryngeal and hypopharyngeal cancers. The patients were planned for endoscopy with white light and narrow-band imaging. The biopsy was carried out in NBI suspected lesions and sent for histopathological examination. The pathologist was blinded to the outcome of NBI and WLE results to eliminate observer bias. The age group most commonly affected in our study was 40-50 years. Out of the 123 patients, 106 were males and 17 were females. The overall Sensitivity, Specificity, Positive predictive value and Negative predictive value of NBI for malignant lesions were 90.6%, 99%, 95.2% and 98% respectively. NBI Technology is a first-rate diagnostic tool that can help in diagnosing early recurrent cancer lesions, especially after RT, in which the recurrence is otherwise difficult to differentiate from post-radiotherapy oedema. This technology can significantly reduce the rates of failure to detect cancers in early stages.

Circulating tumor cells as diagnostic markers of early gastric cancer and gastric precancerous lesions.

Circulating tumor cells (CTCs) may be potential diagnostic biomarkers of various malignancies including gastric cancer. This study aimed to evaluate whether CTCs could be used to facilitate the diagnosis of early gastric cancer (EGC) or precancerous gastric lesions. The diagnostic study included consecutive patients with EGC, gastric precancerous lesions or fundic gland polyps admitted to the Gastroenterology Department, Beijing Friendship Hospital Affiliated to Capital Medical University (National Center for Digestive Diseases) between October 2016 and January 2018. A total of 92 patients were enrolled, including 57 patients with EGC, 14 patients with gastric precancerous lesions and 21 patients with fundic gland polyps (control group). CTCs were detected in 47.89% (34/71) of patients with EGC/gastric precancerous lesions and 4.76% (1/21) of patients with fundic gland polyps (P<0.001). CTC detection distinguished EGC/precancerous lesions from fundic gland polyps with an area under the ROC curve of 0.740 (95% confidence interval, 0.640-0.840; P=0.001), a sensitivity of 49.10%, a specificity of 95.00%, a positive predictive value of 97.00% and a negative predictive value of 64.90%. Peripheral blood CTCs are more common in patients with EGC or gastric precancerous lesions than in patients with fundic gland polyps. Measurement of CTCs may be a useful tool to aid the diagnosis of EGC and precancerous lesions.

Enhanced Classification of Gastric Lesions and Early Gastric Cancer Diagnosis in Gastroscopy Using Multi-Filter AutoAugment

Gastric cancer is high-risk cancer in terms of both incidence and mortality. However, if it is diagnosed early, there is a high chance of survival. Therefore, an early diagnosis of gastric cancer and precancerous lesions is very important. Gastroscopy is one of the best methods for diagnosing gastric cancer and precancerous lesions, but it relies on visual observation by medical specialists. Accordingly, factors such as the experience or fatigue of specialists can influence diagnosis results. To alleviate these problems, we propose a computer-aided diagnosis system that can improve the efficiency of diagnosis and reduce misdiagnoses by providing a second opinion. We aimed to classify healthy tissue, gastric lesions, and early gastric cancer using a Transformer-based deep-learning classification model called Vision Transformer, which has achieved the best performance in transfer learning. We also proposed a Multi-Filter AutoAugment (MFAA) method, which increases the classification performance of the model given small amounts of medical data. The medical data augmented using MFAA are better for training deep-learning models than conventionally augmented data; we effectively enhanced the classification performance of the model using MFAA. In experiments, the model achieved an F1-score of 0.87 and area under the curve of 0.94 in the classification of abnormalities (gastric lesions including early gastric cancer) and healthy tissue. In addition, it obtained an F1-score of 0.92 and area under the curve of 0.97 in the classification of early gastric cancer and non-cancerous gastric lesions.

Endoscopic diagnosis and treatment of early colorectal cancer and precancerous lesions: current status and future prospects

Early detection of colorectal cancer and precursor lesions under colonoscopy, and timely and optimal treatment remain the crucial means for reducing colorectal cancer-related deaths. In this article, we focused on the hot spots in recent years, reviewed the progress of endoscopic diagnosis and treatment of serrated lesions and inflammatory bowel disease (IBD)-related dysplasia, the application of endocytoscopy and the management of early colorectal cancer/precancerous lesions, and provided new prospects for future studies.

Value of serum pepsinogen, gastrin, and cadherin-17 detection combined with narrowband imaging magnifying endoscopy in distinguishing early gastric cancer and precancerous lesions

Value of serum pepsinogen, gastrin, and cadherin-17 detection combined with narrowband imaging magnifying endoscopy in distinguishing early gastric cancer and precancerous lesions

Fully Automated Electronic Cleansing Using CycleGAN in Computed Tomography Colonography

In computed tomography colonography (CTC), an electric cleansing technique is used to mix barium with residual fluid, and colon residue is removed by image processing. However, a nonhomogenous mixture of barium and residue may not be properly removed. We developed an electronic cleansing method using CycleGAN, a deep learning technique, to assist diagnosis in CTC. In this method, an original computed tomography (CT) image taken during a CTC examination and a manually cleansed image in which the barium area was manually removed from the original CT image were prepared and converted to an image in which the barium was removed from the original CT image using CycleGAN. In the experiment, the electric cleansing images obtained using the conventional method were compared with those obtained using the proposed method. The average barium cleansing rates obtained by the conventional and proposed methods were 72.3% and 96.3%, respectively. A visual evaluation of the images showed that it was possible to remove only barium without removing the intestinal tract. Furthermore, the extraction of colorectal polyps and early stage cancerous lesions in the colon was performed as in the conventional method. These results indicate that the proposed method using CycleGAN may be useful for accurately visualizing the colon without barium.

Mechanics of lung cancer: A finite element model shows strain amplification during early tumorigenesis.

Early lung cancer lesions develop within a unique microenvironment that undergoes constant cyclic stretch from respiration. While tumor stiffening is an established driver of tumor progression, the contribution of stress and strain to lung cancer is unknown. We developed tissue scale finite element models of lung tissue to test how early lesions alter respiration-induced strain. We found that an early tumor, represented as alveolar filling, amplified the strain experienced in the adjacent alveolar walls. Tumor stiffening further increased the amplitude of the strain in the adjacent alveolar walls and extended the strain amplification deeper into the normal lung. In contrast, the strain experienced in the tumor proper was less than the applied strain, although regions of amplification appeared at the tumor edge. Measurements of the alveolar wall thickness in clinical and mouse model samples of lung adenocarcinoma (LUAD) showed wall thickening adjacent to the tumors, consistent with cellular response to strain. Modeling alveolar wall thickening by encircling the tumor with thickened walls moved the strain amplification radially outward, to the next adjacent alveolus. Simulating iterative thickening in response to amplified strain produced tracks of thickened walls. We observed such tracks in early-stage clinical samples. The tracks were populated with invading tumor cells, suggesting that strain amplification in very early lung lesions could guide pro-invasive remodeling of the tumor microenvironment. The simulation results and tumor measurements suggest that cells at the edge of a lung tumor and in surrounding alveolar walls experience increased strain during respiration that could promote tumor progression.

Chinese expert consensus on early diagnosis and treatment of esophageal cancer

Although the incidence rate of esophageal cancer in China is on the decline, China is still a high-incidence country of esophageal cancer with great regional variation. In recent years, the five-year survival of esophageal cancer in China has improved significantly. However, due to the absence of typical symptoms in early stage, there still exists a large esophageal cancer diagnostic yield gap between China and developed countries. At present, there are no international guidelines defining the target population for esophageal squamous cell carcinoma (ESCC) screening. Exploring and implementing effective esophageal cancer screening together with early diagnosis and early treatment are the keys to reducing the mortality and improving the survival rate and life quality. Endoscopic therapies, such as endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and radiofrequency ablation (RFA), are used to treat early-stage esophageal cancer. If the tumor invasion is deep or lymph node metastasis is suspected, surgery is needed, meanwhile radiation therapy could also be an optional treatment. Regular follow-up and surveillance are required for any strategy above to deal with relapse and metachronous primary cancers. The Early Diagnosis and Treatment Group of the Chinese Medical Association Oncology Branch has reached an expert consensus on screening and diagnostic protocols for esophageal cancer, on endoscopic and surgical treatment of early esophageal cancer and precancerous lesions, as well as on postoperative monitoring and adjuvant therapy. This consensus follows the evidence-based medicine at both domestic and international levels, combines the current clinical practice and application experience in the treatment of esophageal cancer in China, is based on a multidisciplinary treatment model, and can be used as a reference for clinicians.

Colposcopic Findings of Cervix in VIA (Visual Inspection of Cervix by Acetic Acid) Positive Cases at BSMMU, Dhaka, Bangladesh

Introduction: Cervical cancer is the most common form of cancer in women in developing countries and the second most common form of cancer in the world as a whole. An estimated 468,000 new cases of cervical cancer and 233,000 deaths occurred in the year 2000. Cervical cancer constitutes about 26 % of female cancer in different areas of Bangladesh. Objective: To find out the role of VIA for the detection of precancerous and early cancerous lesions of the cervix with co-relation of Colposcopic findings and ultimate. Methods: A prospective study was conducted from January, 2010 to June 2010 on 100 women attending at the "Colposcopy Clinic" of Gynae Oncology Division of Department of Obstetrics and Gynaecology of BSMMU, Dhaka. Only VIA positive cases were taken into consideration for the study. Results: The mean age of the participants were 33.39 years (range 18-60) with 41.0 % in the age group between 36-45 years. Among all the subjects, the majority (75%) was housewives and 70.0% the patients hailed from urban area. The yearly incomes of 46% families were between 50,000 to 60,000 Tk. The mean parity of the respondents was 1.75 and 4. More than 4 children were found in 14% cases. Up to 35.0% had 2 children only. About 46.0 % had experienced menarche at the age 13 years and the range was 12-14 years. In regard to risk factors, 64% used hormonal methods. Among the participants 80% experienced first coitus of age between 13-20 years. Excessive vaginal discharge and backache were the principal complaints. Colposcopy evaluated 65 cases as CIN (CIN I 34 %, CIN 11-17%, CIN-III 14%) and 3.0% as invasive lesions. Biopsy evaluated 45% as CIN (CIN I-20% CIN-15%, CIN-III 10%) and 1% as invasive lesions. The sensitivity and specificity of colposcopy were 82.14 % and 50.00% respectively. This suggests the role of colposcopy in the evaluation of CIN and cervical cancer. Conclusion: The study concludes that the VIA and colposcopy are the important methods of diagnostic tools for the diagnosis of cervical pre-malignancy. VIA may be used as a tool for screening in underdeveloped countries and may be associated with a referral procedure for further methods like colposcopy and biopsy. Colposcopy is an indispensable procedure in the evaluation of unhealthy cervix through it requires considerable training and experience.

Accuracy of Endoscopic Ultrasonography for Determining the Depth of Invasion in Early Gastric Cancer.

Background:Accurate staging for depth of invasion (T stage) of early gastric cancer is critical for determining the treatment modality. Endoscopic ultrasonography is a reliable method for assessing the T stage. However, its diagnostic accuracy varies. The aim of this study is to investigate clinicopathologic factors affecting the diagnostic accuracy of endoscopic ultrasonography in early gastric cancer.Methods:Patients with early gastric cancer who had undergone endoscopic resection or gastrectomy were included. The diagnostic accuracy of endoscopic ultrasonography was evaluated by comparing the T stage by endoscopic ultrasonography with histopathology of the resected specimen. Subgroup analysis was performed according to the endoscopic resection criteria.Results:A total of 223 early gastric cancer lesions were included. The overall accuracy of endoscopic ultrasonography for T staging was 66.4%. The diagnostic accuracy for lesions ≤2 cm was significantly higher than for those of 2-3 cm (odds ratio 3.59) or those >3 cm (odds ratio 5.47). The diagnostic accuracy was significantly decreased in lesions with ulceration (odds ratio 2.62) or non-flat morphology (odds ratio 2.94). The accuracy of endoscopic ultrasonography for lesions corresponding to the absolute endoscopic resection criteria was significantly higher than for those corresponding to the expanded criteria (97.3% vs 71.9%, P = .002). Of the tumors that were overestimated by endoscopic ultrasonography treated with gastrectomy, 93.3% corresponded to the expanded criteria.Conclusion:Endoscopic ultrasonography had poor accuracy in early gastric cancer lesions larger than 2 cm, those with ulceration, and those with non-flat morphology, that is, lesions corresponding to the expanded criteria were more frequently overstaged by endoscopic ultrasonography. Such early gastric cancers should be carefully considered when staging by endoscopic ultrasonography before gastrectomy.

Preoperative evaluation of endoscopic submucosal dissection for early gastric cancer.

Objective:To retrospectively analyze the preoperative endoscopic evaluation of the size, nature, and depth of lesions in endoscopic submucosal dissection (ESD) for early gastric cancer and precancerous lesions, determine whether the lesions can be completely resected, and reduce the risk of additional surgery after ESD.Methods:A total of 114 patients with high-grade intraepithelial neoplasia(HGIN) and early gastric cancer treated with ESD in Hebei General Hospital from January 2016 to April 2021 were enrolled in this study. The lesions were evaluated preoperatively according to the endoscopic findings of white light, magnifying endoscopy, endoscopic features of narrow band imaging, and preoperative pathology. Lesion size, positive resection margin, lesion depth, and vascular invasion of postoperative pathology were used as criteria.Results:There were 121lesions in 114 patients. The coincidence rates of preoperative and postoperative pathology were 87.21% (75/86) for HGIN and 92.1% (35/38) for adenocarcinoma. There was no significant difference in the coincidence rate between preoperative pathological evaluation and postoperative pathology among the 3 lesions (χ2 = 10.614, P = .005). The type and malignancy of the lesion were not related to its location or size. Magnifying endoscopy combined with narrow-band imaging showed that HGIN and early gastric cancer had clear borders, irregular microvessels, and irregular surface microarchitecture on endoscopic features. Lesions > 3 cm, surface ulcers and spontaneous bleeding may be risk factors for deeper lesions.Conclusion:ESD is not only a method for the treatment of early gastric cancer and precancerous lesions, but is also an important method for definite pathological diagnosis. Accurate preoperative assessment of lesion type, lesion extent and depth of invasion is helpful to improve the complete resection rate of ESD and reduce the risk of additional surgery.

EFFICACY ANALYSIS OF ENDOSCOPIC SUBMUCOSAL DISSECTION FOR THE EARLY GASTRIC CANCER AND PRECANCEROUS LESIONS.

Endoscopic treatment of precancerous lesions and early gastric cancer has been widely accepted in recent years. Endoscopic submucosal dissection (ESD), following established indication criteria, can lead to cure of the disease in more than 90% of cases. This study aimed to analyze the use of ESD in patients with early gastric cancer and precancerous lesions, as well as the results of the procedure, its complications and effectiveness in controlling the disease. This is a retrospective cohort study composed of 41 patients aged from 53 to 87 years (mean age: 65 years; 58.53% male) who were analyzed from 2008 to 2019. The variables collected from the medical records were: comorbidities, classification of the lesion regarding resection criteria, type of resection, histology, degree of invasion, resection margin, complications, disease recurrence. Statistical analysis was performed using the Kruskal-Wallis test, the McNemar's test, and the Mann-Whitney test, with 5% statistical significance (P<0.05). The most frequent site of the lesion was the gastric antrum and the predominant presentation by the Japanese or Paris classification was the one with depressed components in 56.09%. Adenocarcinoma occurred in 75.6% of the biopsies, and the remainder were adenomas without neoplasia. En-bloc resection occurred in 97.57% of cases, and compromise of the safety margin occurred in one patient. The main pre-existing comorbidity was liver cirrhosis in 29.26% of cases. There was a significant increase in post- ESD adenocarcinoma compared to pre-resection diagnosis. The mean follow-up time was 38.4 months, with one recurrence (2.43%) and two metachronous lesions (4.87%). Complications during and after the procedure occurred in three patients (7.31%), being due to bleeding (two cases) and perforation (one case). There was one death due to a cardiac event not directly related to the procedure. Endoscopic submucosal dissection proved to be a safe procedure, with a low complication and recurrence rate. Its recommendation must occur within the established criteria; however, it can be indicated for patients outside the criteria, if there is a high risk for surgical treatment.

Diagnostic Value of Endoscopic Narrow-Band Imaging Technique in Early Gastric Cancer and Precancerous Lesions.

Objective To investigate the diagnostic value of endoscopic narrow-band imaging technique in early gastric cancer and precancerous lesions. Methods A total of 100 patients with recurrent upper gastrointestinal symptoms in our hospital from January 2017 to January 2022 were selected and divided into group A and group B according to the random number table method, with 50 cases in each group. Group A received white light endoscopy, and group B received narrow-band imaging technology combined with endoscopy. Narrow-band imaging combined with magnifying endoscopy was used to stain the area with suspicious mucosal lesions with indigo carmine and magnified observation. Results The endoscopic image clarity of group B was significantly better than that of group A in terms of lesion outline, gastric pit, and microvascular morphology (P < 0.05). There were 10 cases of early gastric cancer, 18 cases of benign lesions, and 9 cases of gastric cancer (nonearly stage); 17 cases of precancerous lesions, 12 cases of early gastric cancer, 13 cases of benign lesions, and 6 cases of gastric cancer (nonearly stage) were diagnosed by ordinary white light endoscopy. Pathological results confirmed that among the 50 patients in group B, there were 15 cases of precancerous lesions, 11 cases of early gastric cancer, 17 cases of benign lesions, and 7 cases of gastric cancer (nonearly stage). Among the 50 patients in group A, 16 were precancerous lesions, 11 were early gastric cancer, 15 were benign lesions, and 8 were gastric cancer (non early stage). In the diagnosis of precancerous lesions and early gastric cancer, the diagnostic consistency, sensitivity, and specificity of group B were better than those of group A (P < 0.05); NBI combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer (kappa = 0.860, kappa = 0.883) was more consistent with pathological diagnosis than common white light endoscopy (kappa = 0.433, kappa = 0.535). Conclusion The value of narrow-band imaging technology combined with endoscopy in the diagnosis of precancerous lesions and early gastric cancer is better than that of ordinary white light endoscopy, and it can be widely used in clinical practice.

Colorectal submucosa thickness in specimens obtained by EMR versus ESD: a retrospective pilot study.

AbstractAccurate histopathology is the mainstay for reliable classification of resected early colorectal cancer lesions in terms of potential risk of lymph node metastasis. In particular, thickness of resected submucosa is important in cases of submucosal invasive cancer. Nevertheless, little is known about the quality and thickness of submucosal tissue obtained using different endoscopic resection techniques. In this small pilot study, we performed morphometric analysis of submucosal thickness in specimens obtained from right-sided colorectal lesions using endoscopic mucosal resection (EMR) versus endoscopic submucosal resection (ESD). Comparative measurements showed significant differences in submucosal area ≥ 1000 μm and minimum submucosal thickness per tissue section analyzed (EMR vs. ESD: 91.2 % ± 6.6 vs. 47.1 % ± 10.6, P = 0.018; 933.7 µm ± 125.1 vs. 319.0 µm ± 123.6, P = 0.009). In contrast, no significant differences were observed in variation coefficient and mean maximum submucosal thickness. Thus, unexpectedly, in this small retrospective pilot study, specimens obtained using EMR had a better preserved submucosal layer than those obtained using ESD – possibly due to the different methods of specimen acquisition. The findings should be kept in mind when attempting to resect lesions suspicious for submucosal invasive cancer.

Effect and mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection

Objective: To explore the role and specific mechanism of glucocorticoids in preventing stenosis after esophageal endoscopic submucosal dissection (ESD). Methods: Data of 81 patients [51 cases were male and 30 cases were female, aged (62.09±7.95) years] undergoing early esophageal cancer or precancerous lesions with a stripping range ≥3/4 circle hospitalized from January 2019 to February 2021 in Department of Gastroenterology, Zhongda Hospital, Southeast University. They were randomly divided into the control group (n=23), oral prednisone acetate group (n=28) and/or combined with local injection Triamcinolone acetonide group (n=30). Analysis the stenosis rates, endoscopic stent dilatation times, the scores of the Atkinson classification and QLQ-OES18 after 12 weeks. Also the expression of carbohydrate sulfotransferase15 (CHST15) mRNA, TGF-β1 and Collagen-Ⅰ protein were compared by real-time PCR or immunohistochemistry. Results: The stenosis rates of the control group, oral prednisone acetate group and/or combined with local injection Triamcinolone acetonide group were 82.6% (19/23), 46.4% (13/28) and 20.0% (6/30) (P<0.001); endoscopic stent dilatation times [M (Q1,Q3)] in these three groups were 2 (1, 3), 0 (0, 0) and 0 (0, 0) (P<0.001). After ESD, the scores of the Atkinson classification and QLQ-OES18 in the three groups were lower than before (P<0.001); and the expression of CHST15 mRNA in the three groups were 4.31±0.13, 3.44±0.07 and 2.84±0.21 respectively (P<0.001). Compared with the control group, the expression of CHST15 mRNA in oral prednisone acetate group was down-regulated (P<0.001), and was the lowest in oral prednisone acetate combined with local injection Triamcinolone acetonide group (P<0.001). As CHST15 mRNA was down-regulated, the expression of TGF-β1 and Collagen-I protein was also down-regulated (P<0.05). Conclusions: Oral prednisone alone or combined with local injection of triamcinolone acetonide both can prevent esophageal stenosis effectively. Oral combined with local injection of glucocorticoid is particularly more effective. Glucocorticoid can reduce the expression of CHST15 mRNA, thereby inhibiting the expression of TGF-β1 and Collagen-I protein.

Linked color imaging improves identification of early gastric cancer lesions by expert and non-expert endoscopists

Background and aimsEarly gastric cancer (EGC) lesions are often subtle and endoscopically poorly visible. The aim of this study is to evaluate the additive effect of linked color imaging (LCI) next to white-light endoscopy (WLE) for identification of EGC, when assessed by expert and non-expert endoscopists.MethodsForty EGC cases were visualized in corresponding WLE and LCI images. Endoscopists evaluated the cases in 3 assessment phases: Phase 1: WLE images only; Phase 2: LCI images only; Phase 3: WLE and LCI images side-to-side. First, 3 expert endoscopists delineated all cases. A high level of agreement between the expert delineations corresponded with a high AND/OR ratio. Subsequently, 62 non-experts indicated their preferred biopsy location. Outcomes of the study are as follows: (1) difference in expert AND/OR ratio; (2) accuracy of biopsy placement by non-expert endoscopists; and (3) preference of imaging modality by non-expert endoscopists.ResultsQuantitative agreement between experts increased significantly when LCI was available (0.58 vs. 0.46, p = 0.007). This increase was more apparent for the more challenging cases (0.21 vs. 0.47, p < 0.001). Non-experts placed the biopsy mark more accurately with LCI (82.3% vs. 87.2%, p < 0.001). Again this increase was more profound for the more challenging cases (70.4% vs. 83.4%, p < 0.001). Non-experts indicated to prefer LCI over WLE.ConclusionThe addition of LCI next to WLE improves visualization of EGC. Experts reach higher consensus on discrimination between neoplasia and inflammation when using LCI. Non-experts improve their targeted biopsy placement with the use of LCI. LCI therefore appears to be a useful tool for identification of EGC.Graphical abstract

Clinical benefit of tunnel endoscopic submucosal dissection for esophageal squamous cancer: a multicenter, randomized controlled trial

Endoscopic submucosal dissection (ESD) is widely accepted as a primary treatment modality for dysplastic and early cancerous lesions of the GI tract. However, prolonged procedure time and life-threatening adverse events remain obstacles to the successful treatment of esophageal cancer. This study aimed to compare the efficacy and safety of tunnel ESD (T-ESD) with conventional ESD (C-ESD) for superficial esophageal squamous neoplasms. A prospective, multicenter trial was conducted at 5 hospitals in China. Patients with esophageal squamous neoplasms were enrolled and randomly assigned to undergo C-ESD or T-ESD. Randomization was stratified by tumor location and circumference extent (<1/2 or≥1/2). The primary endpoint was procedure time. Between January and July 2018, 160 patients were enrolled. One hundred fifty-two patients (76 in the C-ESD group and 76 in the T-ESD group) were included in the final analysis. The median procedure time was 47.3 minutes (interquartile range, 31.7-81.3) for C-ESD and 40.0 minutes (interquartile range, 30.0-60.0) for T-ESD (P= .095). However, T-ESD specifically reduced the median procedure time 34.5% (29.5 minutes) compared with C-ESD for lesions≥1/2 circumference (P< .001). Among the multiple secondary outcomes, muscular injury was less frequent in the T-ESD group compared with the C-ESD group (18.4% vs 38.2%, P= .007), but complete healing of artificial mucosal defect in 1-month follow-up was more common in the T-ESD group than the C-ESD group (95.9% vs 84.7%, P=.026). Our study suggests that T-ESD results in shorter procedure time, specifically for lesions≥1/2 circumference of the esophagus. In addition, T-ESD has a better safety profile indicated by less frequent muscular injury and improved healing of artificial mucosal defects caused by ESD procedures. (Clinical trial registration number: NCT03404921.).

Texture and Color Enhancement Imaging with Indigo Carmine Dye Accentuates Slightly Depressed Early Gastric Cancer Lesions

A 74-year-old man visited our hospital for follow-up esophagogastroduodenoscopy after eradication of Helicobacter pylori. Transnasal endoscopy (GIF-1200N with the EVIS X1 video system, Olympus Medical Systems, Tokyo, Japan) revealed a reddish lesion located in the anterior wall of the prepyloric region on white light imaging (Figure A) using indigo-carmine dye (Figure B). On texture and color enhancement imaging (TXI) mode 1 with indigo-carmine dye (chromo-TXI), the lesion was highlighted as being reddish and slightly depressed (Figure C). Endoscopic submucosal dissection was performed on the suspicion of a well-differentiated tubular adenocarcinoma for biopsy and endoscopic diagnosis. Histologic examination showed the lesion to be adenocarcinoma, well-differentiated, Paris type 0-IIc, measuring 5 × 5 mm, pT1a (M), no lymphovascular invasion (Figure D). TXI is a recently developed technique that enhances brightness, surface irregularities, and subtle color changes. Chromo-TXI facilitated the endoscopic diagnosis of early gastric cancer even with transnasal endoscopy, highlighting slightly depressed lesions, where reddish depressed lesions observed following H pylori eradication are often shown to be indistinguishable from gastric cancer lesions. Thus, chromo-TXI seems to be a more useful modality than white light imaging and may set a new standard for the detection of depressed early gastric cancer lesions.

Scanning point terahertz source microscopy of unstained comedo ductal carcinoma in situ

Terahertz imaging is an emerging candidate to diagnose breast cancers in a label-free manner. However, detailed terahertz analysis of early stage breast cancers is difficult to achieve owing to its low spatial resolution. In this study, utilizing a probe-less terahertz near-field microscope named scanning point terahertz source microscope, we visualize an unstained comedo ductal-carcinoma-in-situ including an architectural structure (comedo necrosis) measuring ∼ϕ500 µm, which is known as highly-malignant early-stage breast cancer, in terahertz images for the first time. The outcome is a critical step toward the label-free diagnosis of single early stage cancer lesions with terahertz waves.

The Role of Transanal Endoscopic Surgery for Early Rectal Cancer.

Transanal endoscopic surgery (TES), which is performed through a variety of transanal endoluminal multitasking surgical platforms, was developed to facilitate endoscopic en bloc excision of rectal lesions as a minimally invasive alternative to radical proctectomy. Although the oncologic safety of TES in the treatment of malignant rectal tumors has been an area of vigorous controversy over the past two decades, TES is currently accepted as an oncologically safe approach for the treatment of carefully selected early and superficial rectal cancers. TES can also serve as both a diagnostic and potentially curative treatment of partially resected unsuspected malignant polyps. In this article, indications and contraindications for transanal endoscopic excision of early rectal cancer lesions are reviewed, as well as selection criteria for the most appropriate transanal excisional approach. Preoperative preparation and surgical technique for complications of TES will be reviewed, as well as recommended surveillance and management of upstaged tumors.