Intrapapillary Capillary Loops Research Articles

Optimal Pathological Prediction of Vocal Fold Leukoplakia Based on IPCLs and Morphology.

To establish a combined classification based on intrapapillary capillary loops (IPCLs) and morphological characteristics to improve the accuracy of pathological prediction of vocal fold leukoplakia (VFL). A prospective research was conducted of VFL patients diagnosed by IPCLs and morphology. The VFL cases were classified as Type I-III based on IPCLs and morphological characteristics. Type I referred to VFL with dendritic vessels but not IPCLs. Type II defined VFL without any IPCLs or vessels and classified by morphology into two subtypes as non-rough Type IIa and rough Type IIb. Type III referred to VFL with IPCLs and classified into two subtypes as Type IIIa with small IPCLs and Type IIIb with large IPCLs or vascular distortion in or around lesions. Predicting pathology accuracy was analyzed. 182 eligible patients were recruited. The prediction accuracy rates of VFL pathology were 81.5% according to the 2019 Ni classification. The combined classification includes 4 cases of Type I, 28 Type IIa, 35 Type IIb, 56 Type IIIa, and 59 Type IIIb VFLs. The prediction accuracy rate of combined classification ranged from 95.1% to 97.3% in three observers. The average sensitivity, specificity, positive predictive value, negative predictive value was 97.8%, 86.2%, 97.4%, 88.2%, respectively. The inter-observer agreement varied from 84.1% to 94.0%, and mean area under curve of receiver-operating curve analysis was 0.954. The new combined classification based on IPCLs and morphological characteristics could predict pathology of VFL accurately. 4 Laryngoscope, 2024.

Microvascular structural changes in esophageal squamous cell carcinoma pathology according to intrapapillary capillary loop types under magnifying endoscopy.

The intrapapillary capillary loop (IPCL) characteristics, visualized using magnifying endoscopy, are commonly assessed for preoperative evaluation of the infiltration depth of esophageal squamous cell carcinoma (ESCC). Japan Esophageal Society (JES) classification is the most widely used classification. Microvascular structural changes are evaluated by magnifying endoscopy for the presence or absence of each morphological factor: tortuosity, dilatation, irregular caliber, and different shapes. However, the pathological characteristics of IPCLs have not been thoroughly investigated, especially the microvascular structures corresponding to the deepest parts of the lesions' infiltration. To investigate differences in pathological microvascular structures of ESCC, which correspond to the deepest parts of the lesions' infiltration. Patients with ESCC and precancerous lesions diagnosed at Peking University Third Hospital were enrolled between January 2019 and April 2023. Patients first underwent magnified endoscopic examination, followed by endoscopic submucosal dissection or surgical treatment. Pathological images were scanned using a three-dimensional slice scanner, and the pathological structural differences in different types, according to the JES classification, were analyzed using nonparametric tests and t-tests. The 35 lesions were divided into four groups according to the JES classification: A, B1, B2, and B3. Statistical analyses revealed significant differences (a P < 0.05) in the short and long calibers, area, location, and density between types A and B. Notably, there were no significant differences in these parameters between types B1 and B2 and between types B2 and B3 (P > 0.05). However, significant differences in the short calibers, long calibers, and area of IPCL were observed between types B1 and B3 (a P < 0.05); no significant differences were found in the density or location (P > 0.05). Pathological structures of IPCLs in the deepest infiltrating regions differ among various IPCL types classified by the JES classification under magnifying endoscopy, especially between the types A and B.

18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters are associated with histological outcomes in superficial esophageal squamous cell carcinoma

Endoscopic submucosal dissection is a standard treatment for early esophageal squamous cell carcinoma. However, submucosal or lymphovascular invasion increases the risk of lymph node metastasis. Although 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters are associated with prognosis in patients with advanced esophageal squamous cell carcinoma, the utility of FDG PET/CT in diagnosing superficial esophageal carcinoma remains unclear. This study aimed to investigate the association between FDG PET/CT parameters and histopathological findings in superficial esophageal carcinoma. Fifty-three patients with superficial esophageal cancer who underwent FDG PET/CT scans before undergoing interventions were retrospectively analyzed. The maximal standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis were significantly higher in the cases with submucosal invasion (T1b) compared with those confined to the muscularis mucosa (T1a). In contrast, classification of intrapapillary capillary loops patterns with magnifying endoscopy did not yield statistical differences between T1a and T1b. Multivariable analysis revealed that SUVmax was the only independent predictor of submucosal and lymphovascular invasion. This study demonstrated that SUVmax may be useful in predicting submucosal and lymphovascular invasion. Thus, the value of SUVmax may guide clinical decision-making in superficial esophageal squamous cell carcinoma.

The Japanese Esophageal Society classification for prediction of superficial esophageal squamous cell neoplasia invasion depth: Validation in a Western population.

The Japan Esophageal Society proposed the JES microvessel classification to assess eligibility of early esophageal squamous cell neoplasia (ESCN) for endoscopic resection based on intrapapillary capillary loop assessment. We aimed to assess its diagnostic reproducibility and accuracy in Western ESCN patients. Intrapapillary capillary loops on endoscopic images of Western ESCN lesions (n=113) collected between 2010 and 2022 were assessed by nine endoscopists, including three Japanese expert endoscopists, three Western expert endoscopists, and three residents-in-training, and graded according to the JES microvessel classification where microvessel type A corresponds with normality or low-grade intraepithelial neoplasia, and microvessel types B1, B2, and B3 correspond with high-grade intraepithelial neoplasia or invasion into the lamina propria, muscularis mucosae or superficial submucosa, and deep submucosa, respectively. Outcomes included overall accuracy in predicting ESCN invasion depth and interobserver agreement. Good interobserver agreement was observed among expert endoscopists (Krippendorf's alpha 0.64, 95% CI 0.57-0.70), while agreement was moderate among residents-in-training (Krippendorf's alpha 0.58, 95% CI 0.52-0.72). Overall accuracy of the JES microvessel classification was 53% (95% CI 42-63), 52% (95% CI 41-62), and 44% (95% CI 34-55) for Japanese endoscopists, Western endoscopists, and residents-in-training, respectively. Sensitivity and specificity for vessel type A, B1, B2, and B3 across assessors were 0%-50% and 89%-100%, 55%-64% and 66%-77%, 42%-71% and 60%-76%, and 10%-24% and 92%-97%, respectively. Negative predictive value ranged between 80% and 85% for B3 vessels. Overall accuracy of the JES microvessel classification in Western ESCN patients is low, though absence of B3 vessels as assessed by experienced endoscopists may predict superficial ESCN amenable to endoscopic resection. www.trialregister.nl; NL8897 (6-9-2020).

Morphological Complexity of Intrapapillary Capillary Loops for Predicting the Invasion Depth of Superficial Esophageal Neoplasms Using Narrow‐Band Imaging

ABSTRACTPredicting the invasion depth of superficial esophageal neoplasms (SENs) is crucial for an indication toward endoscopic treatment. We aimed to develop imaging biomarkers to predict the invasion depth of SENs using the intrapapillary capillary loop (IPCL) patterns. Texture and fractal analyses were performed on IPCL demarcations. Logistic regression models were built to distinguish narrow‐band images (NBIs) of T1b from T1a and high‐grade dysplasia (HGD). Classification performances of a base model composed of the age, sex, height, and body mass index of the patient, and a morphometric model comprising the texture and fractal metrics along with the base model parameters were compared. NBIs of 39 patients including T staging of 6 HGD, 22 T1a, and 11 T1b were analyzed. In the logistic regression by a multivariable generalized linear model classifying histological depths, only texture entropy was significantly and positively associated with the invasion depth. Lower texture entropy of IPCL demarcations was significantly associated with diagnoses of T1b (odds ratio: 0.144, 95% confidence interval: 0.019–0.687) in comparison to the stratum with higher texture entropy. The performance of the morphometric model represented by areas under the receiver operating curves (0.795) was better than that of the base model (0.562). We suggest morphometric analyses, particularly texture entropy, have the potential as image biomarkers to aid in the prediction of SEN invasion depth using IPCL patterns.

Mucosectomy band ligation as a treatment for in situ esophageal carcinoma.

Esophageal squamous cell carcinoma (ESCC) remains the most prevalent subtype of esophageal cancer worldwide. Major risk factors include chronic alcohol consumption and heavy smoking. We present the case of a 65-year-old male with chronic alcoholism and a 75 pack-year smoking history, admitted for his first hydropic decompensation of alcoholic cirrhosis. The patient presented with abdominal distension and discomfort. Physical examination confirmed ascites, and further evaluation indicated decompensated cirrhosis. An upper gastrointestinal endoscopy revealed a 15 mm flat mucosal lesion located 35 cm from the dental arcade, classified as IIb according to the Paris Classification. The lesion had a denuded surface, and narrow band imaging (NBI) showed a brownish appearance with abnormal intrapapillary capillary loops (IPCL), suggesting a degenerative squamous lesion of the esophagus. A computed tomography (CT) scan showed no signs of distant metastasis. Histopathological examination of biopsies confirmed high-grade dysplasia (carcinoma in situ).

Atypical intrapapillary capillary loops in early-stage basaloid squamous cell carcinoma of the esophagus.

Basaloid squamous cell carcinoma of the esophagus (BSCCE) is rare and extremely difficult to identify at early stage.We herein presented a superficial depressed lesion at early stage.

Gastrointestinal: Unusual pathology of an anorectal lesion mimicking a benign laterally spreading tumor.

A 70-year-old woman was referred to our institution for the diagnosis and treatment of an anorectal lesion detected on colonoscopy performed at a previous hospital for hematochezia. Colonoscopy revealed a 32-mm flat elevated lesion in the lower rectum with an anal component extending to the dentate line (Fig. 1a). Chromoendoscopy with indigo carmine spraying demonstrated a papillary surface (Fig. 1b). Magnifying endoscopy with narrowband imaging (NBI) displayed an irregular vessel resembling the intrapapillary capillary loop (IPCL) of the Japan Esophageal Society Classification Type B1 (Fig. 1c). Magnifying endoscopy with 0.05% crystal violet staining revealed the absence of discernible glandular ducts, hindering the evaluation of the pit pattern (Fig. 1d). The endoscopic appearance resembled a large adenoma or condyloma acuminatum; however, the absence of a pit pattern indicated that the lesion was covered with squamous epithelium and not columnar. Moreover, the irregular vessel pattern suggested a neoplastic lesion. Based on these observations, the lesion was diagnosed as a neoplasm originating from the squamous epithelium of the anal canal. Thus, we performed endoscopic submucosal dissection for complete elimination. Histological examination revealed a papillary growing squamous cell carcinoma (SCC) exhibiting low-grade and high-grade atypia and abundant dilated vessels (Fig. 2a). The tumor extended from the anal transitional zone (ATZ) to the rectum and entrapped the rectal crypts (Fig. 2b). Some tumor cells had a clear cytoplasm, indicative of koilocytosis (Fig. 2c), and positive p16 immunohistochemical staining suggested human papillomavirus (HPV) infection (Fig. 2d). The final diagnosis was HPV-associated SCC in situ originating from the ATZ with rectal extension. Anal canal cancer (ACC) is a rare disease that accounts for only 0.3% of all malignancies and is strongly associated with high-risk HPV (HPV-16 and HPV-18). This case was unusual because of the extensive infiltration of the columnar epithelium. Therefore, it might be misidentified as a rectal adenoma. Early ACC shows irregular vessel patterns reminiscent of esophageal SCC on magnified endoscopic NBI, which has been reported to be useful in diagnosing ACC. However, laterally spreading tumor (LST) can exhibit similar irregular capillary vessels. The difference in endoscopic appearance between ACC and LST can be explained by their different epithelial anatomies. ACC develops in the squamous cell epithelium and has no orifice or crypt. In contrast, LST originates from the columnar epithelium and has crypt openings. Condyloma acuminatum has a similar endoscopic appearance but with milder vascular dilatation and caliber changes. In conclusion, HPV-associated anal canal cancer can be suspected in papillary tumors with an irregular esophageal SCC-like vascular pattern and absence of glandular structures. Piecemeal endoscopic mucosal resection can be selected for large adenomas; conversely, en bloc resection is the preferred method for ACC to mitigate the risk of recurrence. To ensure the implementation of appropriate treatment, more attention should be paid to lesions extending along the anal canal to the rectum.

Intrapapillary capillary loop abundance on nonmagnified blue laser imaging in esophageal intramural pseudodiverticulosis.

To the Editor: A 61-year-old male patient with critical alcohol consumption presented with progressive dysphagia and several self-resolved bolus impactions. Index endoscopy indicated a high-grade stricture at 22 cm, warranting passage with a pediatric gastroscope, along with small openings consistent with esophageal intramural pseudodiverticulosis (EIPD). In the distal esophagus, a Schatzki ring emerged with additional pseudodiverticulae. The patient underwent esophageal bougienage to 14 mm. Image-enhanced endoscopy before scheduled repeat bougienage was perfomed, highlighting proximal EIPD on linked color imaging (Fig. 1A).1 Furthermore, linked color imaging illustrated diffuse spots correlating with what has been designated as the “faux uni” pattern on white light endoscopy.2 Apart from illustrating active movements with variations of orifice sizes, further characterization using blue laser imaging (BLI) confirmed absent submucosal vessels, while dot-shaped and line-shaped congested intrapapillary capillary loops (IPCL) were clearly appreciated (Fig. 1B). This finding was accentuated in scarred and pseudodiverticula-bearing segments, suggesting EIPD inflammation-driven microvascular alterations (Fig. 1C). Notwithstanding that IPCL changes notably on magnification endoscopy have been reported in other benign esophageal diseases, such as eosinophilic and/or lymphocytic esophagitis (both excluded in this patient), IPCL alterations have never been reported in EIPD nor in any other chronic inflammatory esophageal disorder on nonmagnified conditions (Fig. 1D). Of note, pathology indicating unspecific chronic inflammation did exclude dysplastic changes.Figure 1.: (A) Linked color imaging (LCI) illustrating esophageal intramural pseudodiverticulosis with several small pseudodivertiular openings alongside diffuse so-called “faux uni” spots. (B) Blue laser imaging (BLI) confirmative of absence of submucosal vessels, while dot-shaped and line-shaped congested intrapapillary capillary loops (IPCL) were noted, potentially correlating with type 2 IPLCs (dilation and elongation) on magnified endoscopy. (C, D) This latter abundance in IPCL potentially attributable to inflammation-driven microvascular alterations was concentrated in segments with marked intramural pseudodiverticulosis and clearly discernible under nonmagnification endoscopy.While the concept of IPCLs, relying on magnification image-enhanced endoscopy, has been developed to highlight early squamous cell dysplasia and neoplasia, its potential role in chronic inflammatory esophageal diseases awaits further evolution.3 Albeit not validated for nonenhanced endoscopic assessment, the findings in this patient may suggest IPLC type 2 with uniform dilation and elongation, likewise suggesting a benign condition.4 Conflicts of interest The authors report no conflicts of interest.

Development of artificial intelligence for the detection and staging of esophageal cancer

: Computer-assisted diagnosis (CAD) using deep learning, based on convolutional neural networks (CNNs), is rapidly developing in modern society and clinical practice. In the medical field of endoscopy, a CAD system can be used in the detection and staging of superficial esophageal cancer. In the detection of superficial esophageal squamous cell carcinoma (ESCC), several studies were reported as using still images of conventional white-light endoscopy and narrow-band imaging (NBI). The sensitivity of CAD systems is over 90%, and in some reports, higher than that of expert endoscopists. In addition, there is a report using video for a validation set that showed good performance. In diagnosing invasion depth, there are reports using conventional white-light imaging, NBI, and magnifying endoscopy with NBI using still images; there are also reports of intrapapillary capillary loop pattern identification using still images. Using white-light endoscopy and NBI, CAD systems showed sensitivity of 84.1–95.4%, specificity of 73.3–79.2%, and accuracy of 80.9–92.9% for differentiating SM1 cancers from SM2 or SM3 cancers in pathology. Additional systems could accurately classify intrapapillary capillary loop patterns as normal or abnormal, with comparable performance to experienced endoscopists. As for esophageal adenocarcinoma (EAC) that arises in Barrett’s esophagus (BE), there are detection reports that show favorable performance. Furthermore, the CAD system from one report identified the location suitable for biopsy; this is helpful for endoscopists because of the difficulty in determining the location of early EAC in BE. Although these studies are still only at research level, excellent performance has been achieved for detecting and staging of superficial esophageal carcinoma by CAD systems. In the near future, CAD systems will support us in detecting and staging esophageal cancers in daily clinical practice, leading to a better prognosis.

AI-assisted identification of intrapapillary capillary loops in magnification endoscopy for diagnosing early-stage esophageal squamous cell carcinoma: a preliminary study.

Esophageal squamous cell carcinoma (ESCC) is one of the most common histological types of esophageal cancers. It can seriously affect public health, particularly in Eastern Asia. Early diagnosis and effective therapy of ESCC can significantly help improve patient prognoses. The visualization of intrapapillary capillary loops (IPCLs) under magnification endoscopy (ME) can greatly support the identification of ESCC occurrences by endoscopists. This paper proposes an artificial-intelligence-assisted endoscopic diagnosis approach using deep learning for localizing and identifying IPCLs to diagnose early-stage ESCC. An improved Faster region-based convolutional network (R-CNN) with a polarized self-attention (PSA)-HRNetV2p backbone was employed to automatically detect IPCLs in ME images. In our study, 2887 ME with blue laser imaging (ME-BLI) images of 246 patients and 493 ME with narrow-band imaging (ME-NBI) images of 81 patients were collected from multiple hospitals and used to train and test our detection model. The ME-NBI images were used as the external testing set to verify the generalizability of the model. The experimental evaluation revealed that the proposed method achieved a recall of 79.25%, precision of 75.54%, F1-score of 0.764 and mean average precision (mAP) of 74.95%. Our method outperformed other existing approaches in our evaluation. It can effectively improve the accuracy of ESCC detection and provide a useful adjunct to the assessment of early-stage ESCC for endoscopists.

Analysis of risk factors for depth of invasion and angiolymphatic invasion for circumferential superficial esophageal squamous cell carcinoma and precancerous lesion

Objective: To analyze clinicopathological features of circumferential superficial esophageal squamous cell carcinoma and precancerous lesions and investigate the risk factors for deep submucosal invasion and angiolymphatic invasion retrospectively. Methods: A total of 116 cases of esophageal squamous epithelial high-grade intraepithelial neoplasia or squamous cell carcinoma diagnosed by gastroscopy, biopsy pathology and endoscopic resection pathology during November 2013 to October 2021 were collected, and their clinicopathological features were analyzed. The independent risk factors of deep submucosal invasion and angiolymphatic invasion were analyzed by logistic regression model. Results: The multivariate logistic regression analysis showed that drinking history (OR=3.090, 95% CI: 1.165-8.200; P<0.05), The AB type of intrapapillary capillary loop (IPCL) (OR=11.215, 95% CI: 3.955-31.797; P<0.05) were the independent risk factors for the depth of invasion. The smoking history (OR=5.824, 95% CI: 1.704-19.899; P<0.05), the presence of avascular area (AVA) (OR=3.393, 95% CI: 1.285-12.072; P<0.05) were the independent factors for the angiolymphatic invasion. Conclusions: The risk of deep submucosal infiltration is greater for circumferential superficial esophageal squamous cell carcinoma patients with drinking history and IPCL type B2-B3 observed by magnifying endoscopy, while the risk of angiolymphatic invasion should be vigilant for circumferential superficial esophageal squamous cell carcinoma patients with smoking history and the presence of AVA observed by magnifying endoscopy. Ultrasound endoscopy combined with narrowband imagingand magnification endoscopy can improve the accuracy of preoperative assessment of the depth of infiltration of superficial squamous cell carcinoma and precancerous lesions and angiolymphaticinvasion in the whole perimeter of the esophagus, and help endoscopists to reasonably grasp the indications for endoscopic treatment.

The Feasibility and Safety of Endoscopic Submucosal Dissection for Circumferential Superficial Esophageal Squamous Cell Neoplasms.

Background It remains controversial whether endoscopic submucosal dissection (ESD) is still appropriate for circumferential superficial esophageal squamous cell neoplasms (SESCN), and few studies compared the short-term and long-term outcomes of ESD with radical surgery. Methods A total of 140 patients with SESCN who underwent ESD or surgery between February 2014 and October 2021 were retrospectively reviewed. The characteristics of patients, operative time, postoperative complications, overall survival (OS), recurrence-free survival (RFS), and quality of life (QOL) were compared between the ESD and surgery groups. The effect of different methods to prevent esophageal stenosis after ESD were analysed. Results Drinking, family history of cancer, macroscopic type, and intrapapillary capillary loop (IPCL) type were independent risk factors for deep submucosal invasion (SM ≥ 200 μm). Smoking and IPCL type were independent predictive factors for angiolymphatic invasion. The average operative time of ESD was significantly shorter than that of surgery (174.5 ± 51.16 min vs. 255.9 ± 88.18 min, p < 0.001). The incidence of perioperative complications in ESD group was significantly lower than that in surgery group (5.5% vs. 19.4%, p = 0.015). The ESD group had significantly better functional scale scores for emotional functioning, cognitive functioning, and global health status, and lower rates of pain, dyspnoea, insomnia, appetite loss, diarrhoea, reflux, and trouble with taste than the surgery group. No significant difference in OS and RFS between ESD and surgery group. Conclusions ESD can significantly shorten the operative time and reduce perioperative complications. Additionally, on the premise of using appropriate measures to prevent postoperative stenosis, ESD can be the first choice for the treatment of SESCN, which could provide better QOL, and the long-term prognosis of ESD is no less than that of surgery.

Beige Mucosa Reflecting Active Sites of Eosinophilic Esophagitis.

We evaluated a 30-year-old woman with a 7-year history of eosinophilic esophagitis (EoE) with an initial complaint of moderate dysphagia. She gradually recovered after receiving proton pump inhibitors and oral budesonide. Only proton pump inhibitors were continued as a maintenance therapy until she developed very mild dysphasia 2 months earlier. Although endoscopy using white light imaging revealed characteristic findings of EoE, such as furrows and rings, with unclear images (Figure A), narrow-band imaging (NBI) revealed beige mucosa regions more clearly (Figure B). Magnified endoscopy using NBI revealed dot-shaped intrapapillary capillary loops and the absence of subepithelial vessels in the beige mucosa (Figure C). Target biopsied beige mucosa specimens revealed numerous intraepithelial eosinophils with basal layer hyperplasia and dilated intercellular spaces, reflecting active sites of EoE, whereas in nonbeige mucosa, normal squamous epithelium with few eosinophils was observed (Figure D). A recent study revealed that the loss or thinning of the superficial differentiated cell layer due to EoE activity allows 415-nm light to contact the hemoglobin component, resulting in a beige color change under NBI (Ayaki M, et al. J Gastroenterol Hepatol. 2022). The presence of beige mucosa under NBI in EoE patients, especially in cases without prominent EoE characteristic findings in white light imaging, indicates a suitable biopsied site for correct EoE diagnosis along with its histological activity.

Accuracy of narrow-band imaging in predicting the histology of anal intraepithelial lesions.

Anal intraepithelial neoplasia (AIN) is the precursor of anal squamous carcinoma, frequently underappreciated by most gastroenterologists. Purpose of the study is to assess the diagnostic accuracy of narrow-band imaging (NBI) in predicting the histology of anal lesions, considering a new NBI classification. This is a retrospective analysis of consecutive patients with suspected anal squamous intraepithelial lesions (SILs) and superficially invasive squamous cell carcinoma (SISCCA) who underwent anorectal-sigmoidoscopy. Three expert endoscopists reviewed all the images collected during colonoscopies in white light and NBI in order to generate a practical classification of three main different NBI patterns. After the modified Delphi process, the final NBI classification, mainly based on intrapapillary capillary loops (IPCL) changes included three different NBI pattern. NBI pattern I: elongation of IPCL toward epithelial surface; NBI pattern 2: thickened and tortuous IPCL; NBI pattern 3: mosaic-like disposition of IPCL. We found that NBI pattern positively correlated to the histologic type of the lesions and tumor grade (Spearman's rho = 0.9671, P = 0.0000). Among 58 anal lesions included, 41/41 (100%) LSILs have been classified as NBI pattern I, 10/11 (90.91%) HSILs as NBI pattern II, 1/11 HSIL as NBI pattern I, 4/4 SISCCA as NBI pattern III and 2/2 invasive cancer as NBI pattern III. Diagnostic accuracy of NBI pattern II or III in predicting histology differentiating HSIL or SISCCA/IC versus LSIL showed a sensitivity of 100%, (95% CI: 92.3-100%) and a specificity of 94.1% (95% CI: 83.8-98.3%). The accuracy of this new NBI score system in predicting the histology of anal lesions showed encouraging data in term of sensitivity and specificity in differentiating HSIL or SISCCA/IC versus LSIL, but the clinical usefulness and application of these findings should be evaluated in a prospective larger study.

ClusterNet: a clustering distributed prior embedded detection network for early-stage esophageal squamous cell carcinoma diagnosis.

Early and accurate diagnosis of esophageal squamous cell carcinoma (ESCC) is important for reducing mortality. Analyzing intrapapillary capillary loops' (IPCLs) patterns on magnification endoscopy with narrow band imaging (ME-NBI) has been demonstrated effective in the diagnosis of early-stage ESCC. However, even experienced endoscopists may face difficulty in finding and classifying countless IPCLs onME-NBI. We propose a novel clustering prior embedded detection network: ClusterNet. ClusterNet is capable of analyzing the distribution of IPCLs on ME-NBI automatically and enables endoscopists to overview multiple types of visualization. With ClusterNet assisting, endoscopists may observe ME-NBI images more efficiently, thus they may also predict the pathology and make medical decisions more easily. We propose the first large-scale ME-NBI dataset with fine-grained annotations by consensus of expert endoscopists. The dataset is splitted into a training set and an independent testing set based on patients. With two strategies for embedding, ClusterNet can automatically take the clustering effect into consideration. Prior to this work, none of the existing approaches take the clustering effect, which is rather important in classifying the IPCLs, into account. ClusterNet achieves an average precision of 81.2% and an average recall of 90.0% for the detection of IPCLs patterns on each patient of the independent testing set. We also compare ClusterNet with other state-of-the-art detection approaches. The performance of ClusterNet with embedding strategies is consistently superior to that of other approaches in terms of average precision, recall andF2-Score. Experiments demonstrate that our proposed method is able to detect almost all the IPCLs patterns on ME-NBI and classify them according to the Japanese Endoscopic Society (JES) classificationaccurately.

Examination of micro-superficial lesions of up to 5 mm in size in the pharyngolaryngeal region.

For low-grade intraepithelial neoplasia cases, pharyngolaryngeal lesions equal to or less than 5 mm in size do not generally progress to invasive carcinoma. However, micro-superficial lesions equal to or less than 5 mm that showed rapid growth have been recently encountered. This study aimed to identify the characteristics of preferential progression of lesions equal to or less than 5 mm in size. Gross findings, endoscopic findings and pathological results of 55 lesions measuring equal to or less than 5 mm in diameter were retrospectively reviewed to identify factors that distinguish squamous cell carcinoma or high-grade intraepithelial neoplasia from low-grade intraepithelial neoplasia or non-atypia lesions. The overall sensitivity, specificity, accuracy, and positive and negative predictive value of background colouration and intrapapillary capillary loop pattern in differentiation of squamous cell carcinoma or high-grade intraepithelial neoplasia from low-grade intraepithelial neoplasia or non-atypia lesions were all 100 per cent. Diagnosis based on background colouration and the intrapapillary capillary loop pattern on narrow-band imaging facilitates the pathological examination of lesions measuring equal to or less than 5 mm.

Expression of VEGF, EGF, and Their Receptors in Squamous Esophageal Mucosa, with Correlations to Histological Findings and Endoscopic Minimal Changes, in Patients with Different GERD Phenotypes.

Background: Gastroesophageal reflux disease (GERD) may present as nonerosive reflux disease (NERD), erosive esophagitis (EE), or be complicated by Barrett’s esophagus (BE). The explanation as to what determines the phenotype of GERD is awaited. Therefore, we assessed the correlation between the growth factors expression and endoscopic as histologic findings in GERD patients. Methods: The squamous esophageal epithelium of 50 patients (20-NERD, 7-EE, 15-BE, 8 controls) was examined by: (1) magnification endoscopy with evaluation of minimal GERD changes such as: microerosions, white spots, palisade blood vessels visibility, and intrapapillary capillary loops (IPCLs) appearance, (2) histology, (3) immunohistochemistry with evaluation of the expression of vascular endothelial growth factor (VEGF), epidermal growth factor (EGF), and their receptors (VEGFR and EGFR). Results: The expression of VEGF, but not VEGFR, EGF, and EGFR, was significantly increased in EE patients compared to NERD patients and controls. VEGF levels correlated significantly with the presence of white spots, but not with other minimal endoscopic and histologic features. The EGFR expression correlated positively with basal cell hyperplasia and enlarged IPCLs. Conclusions: Our findings suggest a correlation between growth factors expression and findings in conventional endoscopy, formation of endoscopic minimal changes, and histologic lesions.

Narrow-band imaging for the diagnosis of nonerosive reflux disease: an international, multicenter, randomized controlled trial

We examined the accuracy of narrow-band imaging (NBI) findings in nonerosive reflux disease (NERD) patients compared with control subjects and the impact of proton pump inhibitor (PPI) therapy on these mucosal changes in a multicenter, double-blind, randomized controlled trial. NERD patients (typical symptoms using a validated GERD questionnaire, absence of erosive esophagitis, and abnormal 48-hour pH study) and control subjects underwent high-definition white-light endoscopy followed by NBI and biopsy sampling of the distal esophagus. Then, NERD patients were randomized to esomeprazole 40 mg/day or placebo for 8 weeks, followed by repeat endoscopy. The presence of distal esophageal mucosal changes on NBI were recorded at baseline and after treatment: intrapapillary capillary loops (IPCLs; number, dilation, and tortuosity), microerosions, increased vascularity, columnar islands, and ridge/villous pattern (RVP) above the squamocolumnar junction. Of 122 screened, 21 NERD and 21 control subjects were identified (mean age, 49.5 ± 14.6 years; 62% men; and 85% white). The combination of IPCL tortuosity, RVP, and microerosions (62% vs 19%, P< .05) had a high specificity (86%) and moderate sensitivity (60%) for NERD with an area under the curve of .74. In 10 NERD patients treated with PPIs, resolution of microerosions was most significant (P= .047) compared with placebo (n= 11). RVP resolved in all NERD patients after therapy (P= .02) and correlated with acid exposure time (P= .004). Papillary length (P= .02) and basal cell thickness (P= .02) significantly correlated with a combination of IPCL tortuosity, RVP, and microerosions. In this randomized controlled trial, RVP on NBI demonstrated a high specificity, correlated with acid exposure time, and improved with PPI therapy, suggesting that it could be used as a surrogate marker for diagnosis of NERD. (Clinical trial registration number: NCT02081404.).

Systematic review with meta-analysis: artificial intelligence in the diagnosis of oesophageal diseases.

SummaryBackgroundArtificial intelligence (AI) has recently been applied to endoscopy and questionnaires for the evaluation of oesophageal diseases (ODs).AimWe performed a systematic review with meta‐analysis to evaluate the performance of AI in the diagnosis of malignant and benign OD.MethodsWe searched MEDLINE, EMBASE, EMBASE Classic and the Cochrane Library. A bivariate random‐effect model was used to calculate pooled diagnostic efficacy of AI models and endoscopists. The reference tests were histology for neoplasms and the clinical and instrumental diagnosis for gastro‐oesophageal reflux disease (GERD). The pooled area under the summary receiver operating characteristic (AUROC), sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR) and diagnostic odds ratio (DOR) were estimated.ResultsFor the diagnosis of Barrett's neoplasia, AI had AUROC of 0.90, sensitivity 0.89, specificity 0.86, PLR 6.50, NLR 0.13 and DOR 50.53. AI models’ performance was comparable with that of endoscopists (P = 0.35). For the diagnosis of oesophageal squamous cell carcinoma, the AUROC, sensitivity, specificity, PLR, NLR and DOR were 0.97, 0.95, 0.92, 12.65, 0.05 and DOR 258.36, respectively. In this task, AI performed better than endoscopists although without statistically significant differences. In the detection of abnormal intrapapillary capillary loops, the performance of AI was: AUROC 0.98, sensitivity 0.94, specificity 0.94, PLR 14.75, NLR 0.07 and DOR 225.83. For the diagnosis of GERD based on questionnaires, the AUROC, sensitivity, specificity, PLR, NLR and DOR were 0.99, 0.97, 0.97, 38.26, 0.03 and 1159.6, respectively.ConclusionsAI demonstrated high performance in the clinical and endoscopic diagnosis of OD.