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Hirai R, Kinugasa H, Yamamoto S, Ako S, Tsutsumi K, Abe M, Miyahara K, Nakagawa M, Otsuka M. Methylation analysis of DCC gene in saliva samples is an efficient method for non-invasive detection of superficial hypopharyngeal cancer. Br J Cancer 2024; 130:1725-1731. [PMID: 38538728 PMCID: PMC11091138 DOI: 10.1038/s41416-024-02654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Advances in upper gastrointestinal endoscopic technology have enabled early detection and treatment of hypopharyngeal cancer. However, in-depth pharyngeal observations require sedation and are invasive. It is important to establish a minimally invasive and simple evaluation method to identify high-risk patients. METHODS Eighty-seven patients with superficial hypopharyngeal cancer and 51 healthy controls were recruited. We assessed the methylation status of DCC, PTGDR1, EDNRB, and ECAD, in tissue and saliva samples and verified the diagnostic accuracy by methylation analyses of their promoter regions using quantitative methylation-specific PCR. RESULTS Significant differences between cancer and their surrounding non-cancerous tissues were observed in the methylation values of DCC (p = 0.003), EDNRB (p = 0.001), and ECAD (p = 0.043). Using receiver operating characteristic analyses of the methylation values in saliva samples, DCC showed the highest area under the curve values for the detection of superficial hypopharyngeal cancer (0.917, 95% confidence interval = 0.864-0.970), compared with those for EDNRB (0.680) and ECAD (0.639). When the cutoff for the methylation values of DCC was set at ≥0.163, the sensitivity to detect hypopharyngeal cancer was 82.8% and the specificity was 90.2%. CONCLUSIONS DCC methylation in saliva samples could be a non-invasive and efficient tool for early detection of hypopharyngeal cancer in high-risk patients.
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Affiliation(s)
- Ryosuke Hirai
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata, Kitaku, Okayama, Okayama, 700-8558, Japan
| | - Hideaki Kinugasa
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata, Kitaku, Okayama, Okayama, 700-8558, Japan.
| | - Shumpei Yamamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata, Kitaku, Okayama, Okayama, 700-8558, Japan
| | - Soichiro Ako
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata, Kitaku, Okayama, Okayama, 700-8558, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata, Kitaku, Okayama, Okayama, 700-8558, Japan
| | - Makoto Abe
- Department of Internal Medicine, Hiroshima City Hospital, 7-33, Motomachi, Nakaku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Koji Miyahara
- Department of Internal Medicine, Hiroshima City Hospital, 7-33, Motomachi, Nakaku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Masahiro Nakagawa
- Department of Internal Medicine, Hiroshima City Hospital, 7-33, Motomachi, Nakaku, Hiroshima, Hiroshima, 730-8518, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata, Kitaku, Okayama, Okayama, 700-8558, Japan
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Kimura Y, Shimizu Y, Taniguchi M, Ito S, Dobashi A, Goda K, Nishimura Y, Yamamoto K, Ichihara S, Watanabe A. Efficacy of endoscopic surveillance for pharyngeal mucosa during endoscopic resection for pharyngeal carcinoma: a multicenter prospective study. Surg Endosc 2024; 38:2497-2504. [PMID: 38466423 DOI: 10.1007/s00464-024-10747-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Since patients with pharyngeal squamous cell carcinoma (SCC) often have multiple pharyngeal lesions, evaluation of pharyngeal lesions before endoscopic resection (ER) is important. However, detailed endoscopic observation of the entire pharyngeal mucosa under conscious sedation is difficult. We examined the usefulness of endoscopic surveillance with narrow band imaging (NBI) and lugol staining for detection of pharyngeal sublesions during ER for pharyngeal SCC under general anesthesia (endoscopic surveillance during treatment; ESDT). METHODS From January 2021 through June 2022, we examined 78 patients who were diagnosed with superficial pharyngeal SCC and underwent ER. They underwent the ESDT and for patients who were diagnosed with new lesions of pharyngeal SCC or high-grade dysplasia (HGD) that were not detected in the endoscopic examination before treatment, ER were performed simultaneously for new lesions and the main lesions. The primary endpoint of this study was the detection rate of new lesions of pharyngeal SCC or HGD in the ESDT. RESULTS Fifteen of the 78 patients were diagnosed as having undetected new pharyngeal lesions in the ESDT and 10 (12.8%) (95% CI 6.9-22.2%) were histopathologically confirmed to have new lesions of pharyngeal SCC or HGD. Among the 13 lesions of SCC or HGD, 8 were found by NBI observation; however, 5 were undetectable using NBI but detectable by lugol staining. All of the 13 lesions had endoscopic findings of pink color sign on lugol staining. CONCLUSIONS Endoscopic surveillance for pharyngeal sublesions during ER for pharyngeal SCC is feasible and useful.
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Affiliation(s)
- Yuki Kimura
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Yuichi Shimizu
- Department of Gastroenterology, National Hospital Organization, Hokkaido Medical Center, 5-7, Yamanote, Nishi-ku, Sapporo, Hokkaido, 063-0005, Japan.
| | - Masanobu Taniguchi
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Suguru Ito
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yusuke Nishimura
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Keiko Yamamoto
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Shin Ichihara
- Department of Surgical Pathology, Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan
| | - Akihito Watanabe
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
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Liu R, Yuan X, Liu S, Hu B. Endoscopic submucosal dissection for a small high grade intraepithelial neoplasia in the hypopharynx detected incidentally by artificial intelligence. Endoscopy 2023; 55:E1240-E1241. [PMID: 38086415 PMCID: PMC10715902 DOI: 10.1055/a-2208-3412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Ruide Liu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
| | - Xianglei Yuan
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
| | - Shuang Liu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
| | - Bing Hu
- Department of Gastroenterology and Hepatology, West China Hospital of Sichuan University, Chengdu, China
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Furue Y, Hori K, Tomioka T, Fujii S, Okano W, Shinozaki T, Kadota T, Yoda Y, Hayashi R, Yano T. Clinical outcome of endoscopic-assisted transoral surgery for superficial cancer of pharyngo-esophageal junction. Head Neck 2023; 45:2098-2107. [PMID: 37350231 DOI: 10.1002/hed.27439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/01/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Endoscopic-assisted transoral surgery (TOS) for superficial cancer of the pharyngo-esophageal junction (PEJ) is risk of stricture, and therapeutic outcomes are unclear. This study aimed to evaluate clinical outcomes of endoscopic-assisted TOS for superficial PEJ cancers. METHODS We retrospectively compared clinical outcomes of endoscopic-assisted TOS for superficial PEJ cancers (group A) and of other sites in the hypopharynx (group B). RESULTS The group A comprised 12 lesions in 12 patients, and group B comprised 198 lesions in 146 patients. Group A and group B exhibited en bloc resection rates of 100% and 99%. Median operative times were 82 and 37 min (p < 0.001). The frequency of stricture and local recurrence in group A was significantly higher in group B (42% vs. 1%, p < 0.001; 25% vs. 6%, p = 0.036). All adverse events could be managed with conservative treatments. CONCLUSIONS Endoscopic-assisted TOS is not ideal for treating superficial PEJ cancers compared to other sites.
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Affiliation(s)
- Yasuaki Furue
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Keisuke Hori
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Gastroenterology, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Satoshi Fujii
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Wataru Okano
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomohiro Kadota
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yusuke Yoda
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
- Department of Endoscopy, Saitama Cancer Center, Kitaadachi, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
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Ominami M, Nagami Y, Kono M, Yamamoto Y, Yokota C, Teranishi Y, Oishi M, Manabe T, Ochiai T, Tanoue K, Yamamura M, Maruyama H, Nadatani Y, Fukunaga S, Otani K, Hosomi S, Tanaka F, Kamata N, Taira K, Sunami K, Fujiwara Y. Risk factors for adverse events associated with endoscopic submucosal dissection for superficial pharyngeal cancer. Surg Endosc 2023; 37:6322-6332. [PMID: 37202526 DOI: 10.1007/s00464-023-10118-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Superficial pharyngeal cancer can be treated with curative intent while preserving function using minimally invasive peroral endoscopic resection techniques such as endoscopic submucosal dissection (ESD). However, severe adverse events occasionally occur, such as laryngeal edema requiring temporary tracheotomy and fistula formation. Therefore, we investigated the risk factors for adverse events associated with ESD for superficial pharyngeal cancer. METHODS This retrospective observational study was conducted at a single institution, and 63 patients who underwent ESD were enrolled. The primary outcome was the risk factors for adverse events associated with ESD. The secondary outcomes were adverse events associated with ESD and their frequency. RESULTS The overall adverse event rate was 15.9% (10/63). The incidence of laryngeal edema requiring prophylactic temporary tracheotomy was 11.1%, while laryngeal edema requiring emergency temporary tracheotomy, postoperative bleeding, aspiration pneumonia, fistula, abscess, and stricture formation occurred in 1.6% of patients, respectively. Logistic regression analyses showed that a history of radiotherapy for head and neck cancer was a risk factor for adverse events (odds ratio [OR], 16.67; 95% confidence interval [CI], 3.04-91.34; p = 0.001). After adjusting the model for differences in the baseline risk factors using the inverse probability of treatment weighting method, the adverse events were found to increase in association with a history of radiotherapy for head and neck cancer (OR, 39.66; 95% CI,5.85-268.72; p < 0.001). CONCLUSION History of radiotherapy for head and neck cancer is an independent risk factor for adverse events associated with ESD for superficial pharyngeal cancer. Among adverse events, laryngeal edema requiring prophylactic temporary tracheotomy was particularly high.
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Affiliation(s)
- Masaki Ominami
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan.
| | - Mitsuhiro Kono
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Yuki Yamamoto
- Department of Otolaryngology and Head and Neck Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Chieko Yokota
- Department of Otolaryngology and Head and Neck Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yuichi Teranishi
- Department of Otolaryngology and Head and Neck Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Oishi
- Department of Otolaryngology and Head and Neck Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Taku Manabe
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Tadashi Ochiai
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Kojiro Tanoue
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Masafumi Yamamura
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Hirotsugu Maruyama
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Yuji Nadatani
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
| | - Kishiko Sunami
- Department of Otolaryngology and Head and Neck Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-Ku, Osaka, Japan
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Outcomes of Endoscopic Submucosal Dissection for Treatment of Superficial Pharyngeal Cancers: Systematic Review and Meta-Analysis. Dig Dis Sci 2022; 67:3518-3528. [PMID: 34505257 DOI: 10.1007/s10620-021-07225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/10/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIMS Studies evaluating the role of endoscopic submucosal dissection (ESD) in the management of superficial pharyngeal cancers have reported promising results. This meta-analysis evaluates the efficacy and safety of ESD in the management of superficial pharyngeal cancers. METHODS We reviewed several databases from inception to September 03, 2020, to identify studies evaluating the efficacy and safety of ESD in the management of superficial pharyngeal cancers. Our outcomes of interest were en bloc resection rate, complete resection rate, adverse events, and rates of local recurrence. Pooled rates with 95% confidence intervals (CI) for all outcomes were calculated using random-effect model. Heterogeneity was assessed by I2 statistic. We assessed publication bias by using funnel plots and Egger's test. We conducted meta-regression analysis to explore heterogeneity in analyses. RESULTS Ten studies were included in analyses. All studies were from Asia. Pooled rates (95% CI) for en bloc resection and complete resection were 94% (87%, 97%) and 72% (62%, 80%), respectively. The pooled rates (95% CI) for adverse events and local recurrence were 10% (5%, 17%) and 1.9% (0.9%, 4%), respectively. Most of the analyses were limited by substantial heterogeneity. On meta-regression analysis, the heterogeneity was explained by size of tumor and histology. Funnel plots and Egger's test showed no evidence of publication bias. CONCLUSIONS This meta-analysis including studies from Asian countries demonstrated that ESD is an efficacious and safe option in the management of superficial pharyngeal cancers. More studies and studies from Western countries are needed to further validate these findings.
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Ogasawara N, Kikuchi D, Tanaka M, Ochiai Y, Okamura T, Hayasaka J, Suzuki Y, Mitsunaga Y, Nomura K, Odagiri H, Yamashita S, Matsui A, Hoteya S. Comprehensive risk evaluation for metachronous carcinogenesis after endoscopic submucosal dissection of superficial pharyngeal squamous cell carcinoma. Esophagus 2022; 19:460-468. [PMID: 35099639 DOI: 10.1007/s10388-022-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/23/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pharyngeal squamous cell carcinoma (PSCC) is associated with a high likelihood of metachronous carcinogenesis, which is known to have a poor prognosis. This study aimed to identify comprehensive risk evaluation indicators for metachronous carcinogenesis after endoscopic submucosal dissection (ESD) of superficial PSCC. METHODS The risk of metachronous carcinogenesis was evaluated in 144 patients with superficial PSCC (with no history of PSCC or esophageal squamous cell carcinoma) who underwent initial ESD from 2008 to 2020. Multiple lugol-voiding lesions (LVLs) in the background pharyngeal and esophageal epithelium were evaluated as endoscopic indicators. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score was analyzed as a serum marker. RESULTS The median follow-up period was 4.3 years. The coincidence rate for pharyngeal and esophageal LVL grade was 55%. The cumulative 3-year metachronous PSCC rate was 18.9%. The cumulative 3-year second metachronous PSCC rate was 43.9%. Forward stepwise multivariate Cox proportional hazards regression analysis identified pharyngeal LVL grade and a lower HALP score as significant independent predictors. Pharyngeal LVL grade was superior to esophageal LVL grade as a predictor of metachronous PSCC. A lower HALP score was significantly associated with younger age in forward stepwise multivariate logistic regression analysis. CONCLUSIONS Patients with a history of superficial PSCC remain at risk for metachronous carcinogenesis over time, and long-term follow-up is imperative. Comprehensive evaluation of endoscopic features with a novel serum marker, namely, the HALP score, can help predict metachronous carcinogenesis.
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Affiliation(s)
- Nobuhiko Ogasawara
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan.
| | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Takayuki Okamura
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Junnosuke Hayasaka
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Yutaka Mitsunaga
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Hiroyuki Odagiri
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Satoshi Yamashita
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-0001, Japan
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Nakajo K, Inaba A, Aoyama N, Takashima K, Kadota T, Yoda Y, Morishita Y, Okano W, Tomioka T, Shinozaki T, Matsuura K, Hayashi R, Akimoto T, Yano T. The characteristics of missed pharyngeal and laryngeal cancers at gastrointestinal endoscopy. Jpn J Clin Oncol 2022; 52:575-582. [DOI: 10.1093/jjco/hyac036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/03/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Understanding the miss rate and characteristics of missed pharyngeal and laryngeal cancers during upper gastrointestinal endoscopy may aid in reducing the endoscopic miss rate of this cancer type. However, little is known regarding the miss rate and characteristics of such cancers. Therefore, the aim of this study was to investigate the upper gastrointestinal endoscopic miss rate of oro-hypopharyngeal and laryngeal cancers, the characteristics of the missed cancers, and risk factors associated with the missed cancers.
Methods
Patients who underwent upper gastrointestinal endoscopy and were pathologically diagnosed with oro-hypopharyngeal and laryngeal squamous cell carcinoma from January 2019 to November 2020 at our institution were retrospectively evaluated. Missed cancers were defined as those diagnosed within 15 months after a negative upper gastrointestinal endoscopy.
Results
A total of 240 lesions were finally included. Eighty-five lesions were classified as missed cancers, and 155 lesions as non-missed cancers. The upper gastrointestinal endoscopic miss rate for oro-hypopharyngeal and laryngeal cancers was 35.4%. Multivariate analysis revealed that a tumor size of <13 mm (odds ratio: 1.96, P=0.026), tumors located on the anterior surface of the epiglottis/valleculae (odds ratio: 2.98, P=0.045) and inside of the pyriform sinus (odds ratio: 2.28, P=0.046) were associated with missed cancers.
Conclusions
This study revealed a high miss rate of oro-hypopharyngeal and laryngeal cancers during endoscopic observations. High-quality upper gastrointestinal endoscopic observation and awareness of missed cancer may help reduce this rate.
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Affiliation(s)
- Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
- Cancer Medicine, Cooperative Graduate School, The Jikei University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Inaba
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | | | | | | | | | - Youhei Morishita
- Department of Head and Neck Surgery, National Cancer Center Hospital East Hospital, Kashiwa, Japan
| | | | | | | | | | | | - Tetsuo Akimoto
- Cancer Medicine, Cooperative Graduate School, The Jikei University Graduate School of Medicine, Tokyo, Japan
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
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Inoue M, Shimizu Y, Taniguchi M, Kimura Y, Furuhashi H, Dobashi A, Ikeya T, Goda K, Kato M, Kato M, Sakamoto N, Watanabe A. Evaluation of the risk of metachronous multiple squamous cell carcinoma of the head and neck after transoral surgery based on the genetic polymorphisms of alcohol dehydrogenase 1B and aldehyde dehydrogenase 2. Carcinogenesis 2021; 42:1232-1238. [PMID: 34546328 DOI: 10.1093/carcin/bgab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/08/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
Patients with superficial head and neck squamous cell carcinoma (HNSCC) can be completely treated by techniques of transoral surgery (TOS). The aim of this study was to evaluate the risk of metachronous multiple HNSCC arising after TOS based on alcohol dehydrogenase 1B (ADH1B) and aldehyde dehydrogenase 2 (ALDH2). We registered patients who underwent TOS for superficial HNSCC. Buccal cell samples were obtained by using a cotton swab to examine two single nucleotide polymorphisms in ADH1B and ALDH2 genotyping. We used Cox proportional hazards models to examine the risk of metachronous HNSCC. A total of 198 patients who underwent TOS for HNSCC were evaluated. In multivariate analysis, risks for second HNSCC were ADH1B*1/*1 [hazard ratio (HR), 1.88; 95% confidence interval (CI), 1.11-3.19; P = 0.02], ALDH2*1/*2 (HR, 2.11; 95% CI, 1.00-5.16; P = 0.048) and alcohol consumption before TOS (HR, 1.17; 95% CI, 1.06-1.27; P = 0.01). The 5-year incidence rates of second primary HNSCC in the temperance group and the non-temperance group were 20.8 and 46.5%, respectively (HR, 0.54; 95% CI, 0.31-0.92; P = 0.02). Cumulative development rates of third HNSCC in the temperance group and non-temperance group at 10 years were 11.3 and 36.1%, respectively (HR, 0.19; 95% CI, 0.03-0.65; P = 0.006). ADH1B*1/*1, ALDH2*1/*2 and moderate or heavy alcohol consumption before treatment are independent risk factors of metachronous HNSCC. Since it was shown that temperance decreased the incidences of second and third metachronous HNSCC, advice to discontinue alcohol drinking is necessary.
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Affiliation(s)
- Masaki Inoue
- Department of Gastroenterology and Hepatology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuichi Shimizu
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Masanobu Taniguchi
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Yuki Kimura
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Hiroto Furuhashi
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Akira Dobashi
- Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Masayuki Kato
- Department of Endoscopy, The Jikei University Katsushika Medical Center, Katsushika-ku, Tokyo, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hakodate, Hokkaido, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akihito Watanabe
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Hokkaido, Japan
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10
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Use of Supraclavicular Flap by End to Side Technique in Pharyngeal SCC: A Case Report and Review of Literature. Case Rep Otolaryngol 2021; 2021:6619916. [PMID: 34336336 PMCID: PMC8298143 DOI: 10.1155/2021/6619916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/19/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives In recent years, conservation laryngeal surgeries, including partial pharyngectomy, have been introduced as an alternative procedure for selected cases of hypopharyngeal squamous cell carcinoma (HSCC). Reconstruction of these defects presents a considerable challenge for the surgeon after partial pharyngectomy due to its circumferential nature. In this case report, we represent the innovative "End to side" technique to reconstruct hypopharyngeal defect using the rolled supraclavicular flap after laryngeal-preserving partial pharyngectomy. Methods and Results A 70-year-old female presented with a history of progressive dysphagia and odynophagia. The evaluations revealed a T3N0M0 SCC of pyriform sinus. The mass was successfully resected through partial pharyngectomy, and the hypopharyngeal defect reconstruction was achieved using the rolled supraclavicular flap via the "End to side" technique. The patient was discharged after decannulation on day 10. The 3-week barium swallow was performed with no evidence of anastomotic leakage, and the oral feeding was started after NG tube removal. At week 5, complete movement of the true vocal cord on the one side and good phonation and deglutition was observed. There was no evidence of recurrence after 1 year. Conclusions Laryngeal-preserving partial pharyngectomy and hypopharyngeal reconstruction with the rolled supraclavicular flap via the "End to side" technique could lead to good oncological and functional outcomes in selected cases of pyriform sinus.
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11
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Katada C, Muto M, Fujii S, Yokoyama T, Yano T, Watanabe A, Iizuka T, Yoshinaga S, Tateya I, Mitani H, Shimizu Y, Takahashi A, Kamijo T, Hanaoka N, Abe M, Shiotani A, Kano K, Asada Y, Matsuhashi T, Umeno H, Okami K, Goda K, Hori S, Ono Y, Terai S, Nagami Y, Takemura K, Kawada K, Ando M, Shimeno N, Arai A, Sakamoto Y, Ichinoe M, Nemoto T, Fujita M, Watanabe H, Shimoda T, Ochiai A, Kato T, Hayashi R. Transoral surgery for superficial head and neck cancer: National Multi-Center Survey in Japan. Cancer Med 2021; 10:3848-3861. [PMID: 33991076 PMCID: PMC8209601 DOI: 10.1002/cam4.3927] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/19/2021] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Head and neck cancers, especially in hypopharynx and oropharynx, are often detected at advanced stage with poor prognosis. Narrow band imaging enables detection of superficial cancers and transoral surgery is performed with curative intent. However, pathological evaluation and real‐world safety and clinical outcomes have not been clearly understood. The aim of this nationwide multicenter study was to investigate the safety and efficacy of transoral surgery for superficial head and neck cancer. We collected the patients with superficial head and neck squamous cell carcinoma who were treated by transoral surgery from 27 hospitals in Japan. Central pathology review was undertaken on all of the resected specimens. The primary objective was effectiveness of transoral surgery, and the secondary objective was safety including incidence and severity of adverse events. Among the 568 patients, a total of 662 lesions were primarily treated by 575 sessions of transoral surgery. The median tumor diameter was 12 mm (range 1–75) endoscopically. Among the lesions, 57.4% were diagnosed as squamous cell carcinoma in situ. The median procedure time was 48 minutes (range 2–357). Adverse events occurred in 12.7%. Life‐threatening complications occurred in 0.5%, but there were no treatment‐related deaths. During a median follow‐up period of 46.1 months (range 1–113), the 3‐year overall survival rate, relapse‐free survival rate, cause‐specific survival rate, and larynx‐preservation survival rate were 88.1%, 84.4%, 99.6%, and 87.5%, respectively. Transoral surgery for superficial head and neck cancer offers effective minimally invasive treatment. Clinical trials registry number: UMIN000008276.
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Affiliation(s)
- Chikatoshi Katada
- Department of Gastroenterology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoshi Fujii
- Department of Molecular Pathology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, Wako, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akihito Watanabe
- Department of Otolaryngology, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | | | - Ichiro Tateya
- Department of Otolaryngology - Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Hiroki Mitani
- Department of Head and Neck Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Yuichi Shimizu
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Akiko Takahashi
- Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan
| | - Tomoyuki Kamijo
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Noboru Hanaoka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Abe
- Department of Gastroenterology and Hepatology, Okayama University Graduate School, Okayama, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Koichi Kano
- Department of Otorhinolaryngology - Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yukinori Asada
- Department of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan
| | - Tamotsu Matsuhashi
- Department of Gastroenterology, Akita University School of Medicine, Akita, Japan
| | - Hirohito Umeno
- Department of Otolaryngology- Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Kenji Okami
- Department of Otolaryngology- Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinichiro Hori
- Department of Endoscopy, NHO Shikoku Cancer Center, Matsuyama, Japan
| | - Yoichiro Ono
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenichi Takemura
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mizuo Ando
- Department of Otolaryngology - Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoto Shimeno
- Department of Gastroenterology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Akihito Arai
- Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasutoshi Sakamoto
- Kitasato Clinical Research Center, Kitasato University School of Medicine, Sagamihara, Japan
| | - Masaaki Ichinoe
- Department of Pathology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuo Nemoto
- Department of Diagnostic Pathology, Showa University School of Medicine, Yokohama Northern Hospital, Yokohama, Japan
| | - Masahiro Fujita
- Department of Clinical Pathology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Hidenobu Watanabe
- Department of Pathology, Pathology and Cytology Laboratories BML INC, Tokyo, Japan
| | - Tadakazu Shimoda
- Department of Diagnostic Pathology, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Atsushi Ochiai
- Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Takakuni Kato
- Department of Otorhinolaryngology - Head and Neck Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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12
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Swei E, Wagh MS. Endoscopic submucosal dissection in the pharynx: Let's start at the very beginning! Gastrointest Endosc 2021; 93:828-830. [PMID: 33741087 DOI: 10.1016/j.gie.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Eric Swei
- Division of Gastroenterology, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
| | - Mihir S Wagh
- Division of Gastroenterology, University of Colorado-Denver School of Medicine, Aurora, Colorado, USA
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13
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Kimura Y, Watanabe A, Shimizu Y, Goda K, Ito S, Nishimura Y, Inoue M, Taniguchi M. Evaluation of Pharyngeal Background Mucosa in Patients with Superficial Hypopharyngeal Carcinoma. Laryngoscope 2021; 131:2036-2040. [PMID: 33729575 DOI: 10.1002/lary.29524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/24/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS Transoral surgery (TOS) has become increasingly popular for patients with superficial hypopharyngeal squamous cell carcinoma (SCC). However, the number of patients in whom metachronous multiple SCC of the head and neck (HNSCC) occurs has also increased. In this study, we investigated whether multiple lugol-voiding lesions (LVLs) in the pharyngeal background mucosa observed during TOS would be a biomarker of metachronous HNSCC. STUDY DESIGN Retrospective study. METHODS We examined 362 patients who underwent TOS for superficial hypopharyngeal carcinoma. Endoscopic images were reviewed in a blinded fashion by two endoscopists. LVLs in the pharyngeal mucosa were graded as follows: A, no lesions; B, 1 to 4 lesions; and C, ≥5 lesions per endoscopic view. RESULTS Cumulative incidence curves of secondary HNSCC in the groups of grades A, B, and C revealed 3-year incidence rates of 14.4%, 18.8%, and 29.3%, respectively (P = .001 for A vs. C and P = .002 for B vs. C). Cumulative incidence curves of third HNSCC in the groups of grades A, B. and C revealed 5-year incidence rates of 3.9%, 9.8%, and 19.6%, respectively (P = .001 for A vs. C and P = .006 for B vs. C). Cumulative incidence curves of fourth HNSCC in the groups of grades A, B, and C revealed 7-year incidence rates of 0%, 2.3%, and 13.2%, respectively (P = .025 for A vs. C and P = .009 for B vs. C). CONCLUSIONS Multiple LVLs in the pharyngeal mucosa increase the risk of development of metachronous multiple HNSCC. LEVEL OF EVIDENCE 3 (nonrandomized, controlled cohort/follow-up study) Laryngoscope, 131:2036-2040, 2021.
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Affiliation(s)
- Yuki Kimura
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Akihito Watanabe
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Yuichi Shimizu
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Kenichi Goda
- Department of Gastroenterology, Dokkyo Medical University, Tochigi, Japan
| | - Suguru Ito
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
| | - Yusuke Nishimura
- Department of Gastroenterology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masaki Inoue
- Department of Gastroenterology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masanobu Taniguchi
- Department of Otolaryngology Head and Neck Surgery, Keiyukai Sapporo Hospital, Sapporo, Japan
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14
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Suzuki H, Yoshitaka T, Yoshio T, Tada T. Artificial intelligence for cancer detection of the upper gastrointestinal tract. Dig Endosc 2021; 33:254-262. [PMID: 33222330 DOI: 10.1111/den.13897] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
In recent years, artificial intelligence (AI) has been found to be useful to physicians in the field of image recognition due to three elements: deep learning (that is, CNN, convolutional neural network), a high-performance computer, and a large amount of digitized data. In the field of gastrointestinal endoscopy, Japanese endoscopists have produced the world's first achievements of CNN-based AI system for detecting gastric and esophageal cancers. This study reviews papers on CNN-based AI for gastrointestinal cancers, and discusses the future of this technology in clinical practice. Employing AI-based endoscopes would enable early cancer detection. The better diagnostic abilities of AI technology may be beneficial in early gastrointestinal cancers in which endoscopists have variable diagnostic abilities and accuracy. AI coupled with the expertise of endoscopists would increase the accuracy of endoscopic diagnosis.
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Affiliation(s)
- Hideo Suzuki
- Department of Gastroenterology, Graduate School of Institute Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tokai Yoshitaka
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tada
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,AI Medical Service Inc., Tokyo, Japan.,Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
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15
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Tamashiro A, Yoshio T, Ishiyama A, Tsuchida T, Hijikata K, Yoshimizu S, Horiuchi Y, Hirasawa T, Seto A, Sasaki T, Fujisaki J, Tada T. Artificial intelligence-based detection of pharyngeal cancer using convolutional neural networks. Dig Endosc 2020; 32:1057-1065. [PMID: 32064684 DOI: 10.1111/den.13653] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The prognosis for pharyngeal cancer is relatively poor. It is usually diagnosed in an advanced stage. Although the recent development of narrow-band imaging (NBI) and increased awareness among endoscopists have enabled detection of superficial pharyngeal cancer, these techniques are still not prevalent worldwide. Nevertheless, artificial intelligence (AI)-based deep learning has led to significant advancements in various medical fields. Here, we demonstrate the diagnostic ability of AI-based detection of pharyngeal cancer from endoscopic images in esophagogastroduodenoscopy. METHODS We retrospectively collected 5403 training images of pharyngeal cancer from 202 superficial cancers and 45 advanced cancers from the Cancer Institute Hospital, Tokyo, Japan. Using these images, we developed an AI-based diagnostic system with convolutional neural networks. We prepared 1912 validation images from 35 patients with 40 pharyngeal cancers and 40 patients without pharyngeal cancer to evaluate our system. RESULTS Our AI-based diagnostic system correctly detected all pharyngeal cancer lesions (40/40) in the patients with cancer, including three small lesions smaller than 10 mm. For each image, the AI-based system correctly detected pharyngeal cancers in images obtained via NBI with a sensitivity of 85.6%, much higher sensitivity than that for images obtained via white light imaging (70.1%). The novel diagnostic system took only 28 s to analyze 1912 validation images. CONCLUSIONS The novel AI-based diagnostic system detected pharyngeal cancer with high sensitivity. It could facilitate early detection, thereby leading to better prognosis and quality of life for patients with pharyngeal cancers in the near future.
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Affiliation(s)
- Atsuko Tamashiro
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| | - Akiyoshi Ishiyama
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tsuchida
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazunori Hijikata
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shoichi Yoshimizu
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yusuke Horiuchi
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.,Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| | - Akira Seto
- Department of, Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toru Sasaki
- Department of, Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junko Fujisaki
- Department of, Departments of, Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tada
- AI Medical Service Inc., Tokyo, Japan.,Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
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16
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Yamaguchi H, Sato H, Tsukahara K, Kagawa Y, Okamoto I, Shimizu A, Nagata N, Fukuzawa M, Sugimoto M, Kawai T, Itoi T. Co-treatment with endoscopic laryngopharyngeal surgery and endoscopic submucosal dissection. Auris Nasus Larynx 2020; 48:457-463. [PMID: 33067052 DOI: 10.1016/j.anl.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Endoscopic laryngopharyngeal surgery (ELPS) is an effective and minimally invasive treatment for pharyngeal cancers. However, the disadvantages of ELPS are the interference of instruments in the operative field and the difficulty in approaching certain areas. To overcome these drawbacks, we began to perform combination treatment of ELPS and endoscopic submucosal dissection (ESD). The aim of the present study was to compare the efficacies of treatment with ELPS alone and ELPS combined with ESD. METHODS A total of 103 lesions in 73 patients who underwent pharyngeal ELPS for superficial pharyngeal cancer between August 2014 and January 2020 at our hospital were analyzed. Lesions were divided into the ELPS alone group and ELPS combined with ESD group. Lesion characteristics, technical results, adverse events, and long-term outcomes were analyzed. RESULTS In the ELPS combined with ESD group, procedure speed was shorter than the ELPS alone group (20.2 ± 10.0 mm2/min vs 13.0 ± 6.6 mm2/min, p < 0.001), and R0 resection rate was higher (67.4% vs 45.6%, p = 0.027). There were no significant differences in tumor size, depth of tumor invasion, and adverse events among the 2 groups. These results remained unchanged after propensity score matching. The overall and cause-specific survival rates at 3 years were 96.7% and 100% for the ELPS combined with ESD group and ELPS alone group, respectively. CONCLUSIONS Combination treatment of ESD and ELPS enabled more efficient resection than ELPS alone. Cooperative treatment of pharyngeal cancer patients involving gastroenterologists and head and neck surgeons is effective and beneficial, and results in favorable long-term outcomes.
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Affiliation(s)
- Hayato Yamaguchi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Hiroki Sato
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yasuyuki Kagawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Isaku Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Akira Shimizu
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Naoyoshi Nagata
- Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | | | - Takashi Kawai
- Endoscopy Center, Tokyo Medical University Hospital, Tokyo, Japan
| | - Takao Itoi
- Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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17
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Sugimoto S, Fuke T, Kobayashi D, Ueda K, Sawa M, Kaneko M, Fukukita K, Temma T, Nomura T, Fuwa N, Yamada H. Efficacy of polyglycolic acid sheets and fibrin glue for the prevention of post-ELPS bleeding. Auris Nasus Larynx 2020; 48:471-476. [PMID: 33067053 DOI: 10.1016/j.anl.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of a covering method using polyglycolic acid (PGA) sheets and fibrin glue in preventing laryngopharyngeal bleeding after endoscopic laryngopharyngeal surgery (ELPS) combined with endoscopic submucosal dissection (ESD). METHODS Twenty-one patients who underwent ELPS combined with ESD (28 resected pharyngeal carcinomas) were retrospectively evaluated. After completing ELPS combined with ESD, fibrinogen was sprayed onto the ulcer. A PGA sheet cut into 5 × 5 mm pieces that fit the size of the ELPS-induced ulcer was then placed over the ulcer and fixed in place with a fibrin glue comprising thrombin. RESULTS The resection procedure was performed for all lesions. The median long diameter of the resected specimen was 36 mm. The rate of a resected specimen diameter >30 mm, use of anticoagulant/platelet, and macroscopic classification 0-Ⅱa were 68% (19/28), 19% (5/28), and 36% (10/28), respectively. The median time required to cover ELPS-induced ulcers using PGA sheets and fibrin glue was 10 min (range: 3-22 min). No post-ELPS bleeding, subcutaneous emphysema, or aspiration pneumonia (0/28) was observed. CONCLUSION The covering method using PGA sheets and fibrin glue for ELPS-induced ulcers is considered to be sufficiently safe and effective in preventing post-ELPS laryngopharyngeal bleeding. This method could be useful in preventing post-ELPS bleeding in patients with head and neck cancer.
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Affiliation(s)
- Shinya Sugimoto
- Divisions of Gastroenterology, Ise Red Cross Hospital, 471-2, 1, Funae, Ise, Mie 516-8512, Japan
| | - Tomohito Fuke
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Daisuke Kobayashi
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Kohki Ueda
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Masahiro Sawa
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Mamika Kaneko
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Kohei Fukukita
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Taishi Temma
- Divisions of Gastroenterology, Ise Red Cross Hospital, 471-2, 1, Funae, Ise, Mie 516-8512, Japan
| | - Tatsuma Nomura
- Divisions of Gastroenterology, Ise Red Cross Hospital, 471-2, 1, Funae, Ise, Mie 516-8512, Japan
| | - Nobukazu Fuwa
- Divisions of Radiation Oncology, Ise Red Cross Hospital, Mie, Japan
| | - Hiroyuki Yamada
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan.
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18
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Kanesaka T, Matsuura N, Ishihara R, Fujii T, Kitamura M. Endoscopic resection of a squamous cell carcinoma on a pharyngeal flap. VideoGIE 2020; 5:539-541. [PMID: 33204910 PMCID: PMC7651834 DOI: 10.1016/j.vgie.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Takashi Kanesaka
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masanori Kitamura
- Department of Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
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19
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Namikawa K, Hirasawa T, Yoshio T, Fujisaki J, Ozawa T, Ishihara S, Aoki T, Yamada A, Koike K, Suzuki H, Tada T. Utilizing artificial intelligence in endoscopy: a clinician's guide. Expert Rev Gastroenterol Hepatol 2020; 14:689-706. [PMID: 32500760 DOI: 10.1080/17474124.2020.1779058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) that surpasses human ability in image recognition is expected to be applied in the field of gastrointestinal endoscopes. Accordingly, its research and development (R &D) is being actively conducted. With the development of endoscopic diagnosis, there is a shortage of specialists who can perform high-precision endoscopy. We will examine whether AI with excellent image recognition ability can overcome this problem. AREAS COVERED Since 2016, papers on artificial intelligence using convolutional neural network (CNN in other word Deep Learning) have been published. CNN is generally capable of more accurate detection and classification than conventional machine learning. This is a review of papers using CNN in the gastrointestinal endoscopy area, along with the reasons why AI is required in clinical practice. We divided this review into four parts: stomach, esophagus, large intestine, and capsule endoscope (small intestine). EXPERT OPINION Potential applications for the AI include colorectal polyp detection and differentiation, gastric and esophageal cancer detection, and lesion detection in capsule endoscopy. The accuracy of endoscopic diagnosis will increase if the AI and endoscopist perform the endoscopy together.
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Affiliation(s)
- Ken Namikawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Tsuyoshi Ozawa
- Department of Surgery, Teikyo University School of Medicine , Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Hideo Suzuki
- Department of Gastroenterology, Graduate School of Institute Clinical Medicine, University of Tsukuba , Ibaraki, Japan
| | - Tomohiro Tada
- Department of Surgical Oncology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan.,AI Medical Service Inc ., Tokyo, Japan.,Tada Tomohiro the Institute of Gastroenterology and Proctology , Saitama, Japan
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Kishimoto Y, Tateya I, Funakoshi M, Miyamoto SI, Muto M, Omori K. Endoscopic laryngopharyngeal surgery for hypopharyngeal lesions. Oral Oncol 2020; 106:104655. [PMID: 32325303 DOI: 10.1016/j.oraloncology.2020.104655] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/27/2020] [Accepted: 03/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Transoral approaches for laryngeal/pharyngeal malignancies have been widely accepted as minimally invasive treatment options; however, hypopharyngeal lesions treated by transoral surgery have rarely been reported due to the difficulties in visualizing the hypopharynx. Since 2010, we have treated superficial hypopharyngeal lesions with endoscopic laryngopharyngeal surgery (ELPS), and herein report the outcomes of this transoral procedure. MATERIALS AND METHODS One hundred and eighteen patients with superficial hypopharyngeal lesions were treated by ELPS from February 2010 to February 2017, and the clinical courses of the patients were reviewed. RESULTS Four females and 114 males (average: 65.6 y-o) were included in this study. Some patients had multiple lesions and a total of 154 superficial hypopharyngeal lesions (dysplasia: 29, Tis: 52, T1: 44, T2: 20, T3: 9) were treated with ELPS. Ten patients had only dysplasia and no carcinoma. Five patients presented with nodal metastases and 11 patients had simultaneous oropharyngeal lesions. In all cases, the hypopharynx was well visualized with sufficient working space, and no cases required a change in surgical approach. All post-operative complications were safely managed. In regard to the oncological outcomes, of the 108 patients with malignant lesions, the 3-year and 5-year overall survival (OS) rate was 93.6% and 85.5%, respectively. CONCLUSIONS During ELPS, the hypopharynx was well visualized providing sufficient working space for the resection. The procedure was safe and feasible for superficial hypopharyngeal lesions and exhibited very good oncological outcomes. ELPS is thought to be a very effective surgical alternative for superficial hypopharyngeal lesions.
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Affiliation(s)
- Yo Kishimoto
- Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Ichiro Tateya
- Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan; Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Fujita Health University, Japan.
| | - Makiko Funakoshi
- Preemptive Medicine and Lifestyle-Related Disease Research Center, Kyoto University Hospital, Japan
| | - Shin-Ichi Miyamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan; Department of Gastroenterology and Hepatology, National Hospital Organization Kyoto Medical Center, Japan
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Koichi Omori
- Department of Otolaryngology Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Japan
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21
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Lee J, Chen KM, Chang C, Liu Y, Yang C. Endoscopic submucosal dissection for superficial pharyngeal squamous cell carcinoma. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Jyong‐Hong Lee
- Division of Gastroenterology, Department of Internal Medicine Show Chwan Memorial Hospital Changhua Taiwan
| | - Kwei Ming Chen
- Division of Gastroenterology, Department of Internal Medicine Show Chwan Memorial Hospital Changhua Taiwan
| | - Chi‐Hsien Chang
- Division of Gastroenterology, Department of Internal Medicine Show Chwan Memorial Hospital Changhua Taiwan
| | - Yu‐Tsai Liu
- Division of Gastroenterology, Department of Internal Medicine Show Chwan Memorial Hospital Changhua Taiwan
| | - Chi‐Chieh Yang
- Division of Gastroenterology, Department of Internal Medicine Show Chwan Memorial Hospital Changhua Taiwan
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Kato M, Hayashi Y, Uema R, Saiki H, Kimura K, Inoue T, Sakatani A, Yoshii S, Tsujii Y, Shinzaki S, Hida E, Iijima H, Takehara T. Usefulness of a dedicated mouthpiece for the Valsalva maneuver to visualize the hypopharynx during transoral endoscopy. Endosc Int Open 2020; 8:E536-E543. [PMID: 32258376 PMCID: PMC7089799 DOI: 10.1055/a-1099-9130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/02/2019] [Indexed: 12/30/2022] Open
Abstract
Background and study aims Patients with esophageal squamous cell carcinoma (SCC) are at high risk of developing second primary SCCs in the hypopharynx. However, such second primary tumors are difficult to observe because of lumen closure. The Valsalva maneuver using a dedicated mouthpiece is a promising technique to visualize the hypopharynx during transoral endoscopy. In the current study, we investigated the utility of this method. Patients and methods The current study was a randomized, controlled, crossover trial. Patients with esophageal SCC were randomly assigned first to undergo pharyngeal observation using the dedicated mouthpiece followed by observation using a conventional mouthpiece, or vice versa. The primary endpoint was complete visualization of the hypopharynx, which was assessed blindly by three external evaluators. Results A total of 68 pharyngeal examinations were analyzed - 34 with the dedicated mouthpiece and 34 with a conventional mouthpiece. Complete visualization was achieved in 68 % of the examinations (23/34) using the dedicated mouthpiece, whereas none of the examinations using the conventional mouthpiece achieved complete visualization of the hypopharynx. Observation scores of the oropharynx were not significantly different between both types of examination ( P = 0.50). No serious adverse events (AEs) occurred. Conclusions Endoscopic view of the hypopharynx was markedly improved by the Valsalva maneuver using the dedicated mouthpiece, with no serious AEs. This procedure should be included in the endoscopic examinations for the patients with esophageal SCCs.
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Affiliation(s)
- Minoru Kato
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshito Hayashi
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Ryotaro Uema
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hirotsugu Saiki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keiichi Kimura
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takanori Inoue
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akihiko Sakatani
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunsuke Yoshii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshiki Tsujii
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shinichiro Shinzaki
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eisuke Hida
- Department of Biostatics and Data Science, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Iijima
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuo Takehara
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Japan
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Katada C, Okamoto T, Ichinoe M, Sakamoto Y, Kano K, Hosono H, Miyamoto S, Tanabe S, Koizumi W, Yamashita T. Prediction of lymph-node metastasis and lymphatic invasion of superficial pharyngeal cancer on narrow band imaging with magnifying endoscopy. Auris Nasus Larynx 2020; 47:128-134. [DOI: 10.1016/j.anl.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 01/04/2023]
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Mizushima T, Ohnishi S, Shimizu Y, Hatanaka Y, Hatanaka KC, Kuriki Y, Kamiya M, Homma A, Yamamoto K, Ono S, Urano Y, Sakamoto N. Rapid detection of superficial head and neck squamous cell carcinoma by topically spraying fluorescent probe targeting dipeptidyl peptidase-IV. Head Neck 2018; 40:1466-1475. [PMID: 29509281 DOI: 10.1002/hed.25126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/15/2017] [Accepted: 01/26/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A fluorescent probe glutamylprolyl hydroxymethyl rhodamine green (EP-HMRG), which becomes fluorescent after cleavage by dipeptidyl peptidase-IV (DPP-IV), has been reported to be useful for the detection of esophageal cancer. Thus, we investigated whether head and neck squamous cell carcinoma (HNSCC) can be detected by spraying EP-HMRG. METHODS Fluorescence imaging of 17 cases of HNSCCs resected using endoscopic or surgical resection was performed ex vivo after spraying EP-HMRG, and then the fluorescence intensity of the tumors and normal mucosa were measured. RESULTS Iodine-voiding lesions became fluorescent within a few minutes after the application of EP-HMRG in 12 resected tumors without a history of radiotherapy but this was not observed in the normal mucosa. Fluorescence intensity in tumor lesions was significantly higher than normal lesions. However, 5 other tumors that developed after radiotherapy did not have sufficient contrast against normal mucosa. CONCLUSION Fluorescence imaging with EP-HMRG would be useful for rapid detection of superficial HNSCC without a history of radiotherapy.
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Affiliation(s)
- Takeshi Mizushima
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shunsuke Ohnishi
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuichi Shimizu
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Yutaka Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Yugo Kuriki
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mako Kamiya
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keiko Yamamoto
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Shouko Ono
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Yasuteru Urano
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Japan Agency for Medical Research and Development (AMED)-CREST, Tokyo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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25
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Mizushima T, Ohnishi S, Hosono H, Yamahara K, Tsuda M, Shimizu Y, Kato M, Asaka M, Sakamoto N. Oral administration of conditioned medium obtained from mesenchymal stem cell culture prevents subsequent stricture formation after esophageal submucosal dissection in pigs. Gastrointest Endosc 2017; 86:542-552.e1. [PMID: 28153569 DOI: 10.1016/j.gie.2017.01.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/16/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) for esophageal cancer often causes postoperative stricture when more than three fourths of the circumference of the esophagus is dissected. Mesenchymal stem cells are a valuable cell source in regenerative medicine, and conditioned medium (CM) obtained from mesenchymal stem cells reportedly inhibits inflammation. In this study we evaluated whether CM could prevent esophageal stricture after ESD. METHODS We resected a semi-circumference of pig esophagus by ESD. We prepared CM gel by mixing with 5% carboxymethyl cellulose and endoscopically applied it onto the wound bed immediately after ESD and on days 8 and 15 (weekly CM group) or administered it orally from days 1 to 4 (daily CM group). We also injected triamcinolone acetonide into the remaining submucosa immediately after ESD (steroid group). We killed the pigs on day 8 or day 22 to measure the stricture rate and to perform histologic analysis. RESULTS Stricture rate in weekly and daily CM groups and steroid groups were significantly lower than in the control group on day 22. Moreover, CM significantly attenuated the number of activated myofibroblasts and fiber thickness on day 22. CM also significantly decreased the infiltration of neutrophils and macrophages compared with the control group on day 8. CONCLUSIONS CM gel prevents esophageal stricture formation by suppressing myofibroblast activation and fibrosis after the infiltration of neutrophils and macrophages. Oral administration of CM gel is a promising treatment for the prevention of post-ESD stricture.
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Affiliation(s)
- Takeshi Mizushima
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shunsuke Ohnishi
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidetaka Hosono
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenichi Yamahara
- Department of Transfusion Medicine and Cell Therapy, Hyogo College of Medicine, Nishinomiya, Japan
| | - Momoko Tsuda
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuichi Shimizu
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Mototsugu Kato
- Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Asaka
- Department of Cancer Preventive Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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26
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Yamamoto S, Yashima K, Kawata S, Hosoda K, Tamoto A, Ikebuchi Y, Matsumoto K, Kawaguchi K, Harada K, Murawaki Y, Isomoto H. Frequent aberrant p53 and Fhit expression in endoscopically resected superficial hypopharyngeal cancer and esophageal cancer. Oncol Lett 2017; 14:587-592. [PMID: 28693209 PMCID: PMC5494673 DOI: 10.3892/ol.2017.6271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 02/17/2017] [Indexed: 01/29/2023] Open
Abstract
In the last decade, the incidence rate of detection rate of superficial head, neck and esophageal squamous cell carcinomas has increased with the development of endoscopic imaging techniques. These cancers are thought to arise independently subsequent to tissue exposure to a common carcinogen e.g. alcohol or tobacco. This phenomenon has been termed field cancerization. To determine the molecular background of the development of hypopharyngeal squamous cell carcinomas (HPSCCs) and double esophageal squamous cell carcinomas (DESCCs), the present study immunohistochemically assessed tumor-related protein expression [p53, Fhit (fragile histidine triad), E-cadherin and activation-induced cytidine deaminase (AID)], and subsequently determined the correlation between protein expression and clinicopathological data. Tumor specimens of 9 HPSCCs and 9 DESCCs were endoscopically obtained from 8 patients with HPSCC. The 9 DESCCs, including 5 synchronous and 4 metachronous lesions, were all obtained from four patients with HPSCC. The overexpression of p53 and loss of Fhit expression was immunohistochemically detected in 8 (88.9%) and 8 (88.9%) of the 9 HPSCCs and in 8 (88.9%) and 8 (88.9%) of the 9 DESCCs, respectively, which demonstrated the high frequency of such expression. Additionally, 7 out of 9 HPSCCs, and 7 out of 9 DESCCs demonstrated aberrant expression of p53 and Fhit. The rate of aberrant AID and E-cadherin expression was 67 and 44% in HPSCCs and 44 and 44% in DESCC, respectively. These results suggested that aberrant p53 and Fhit expression was involved in the development of HPSCC and their DESCC, and that their expression may be used for the prediction of DESCC development in patients with HPSCC, thereby acting as a biomarker of field cancerization.
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Affiliation(s)
- Sohei Yamamoto
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Kazuo Yashima
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Soichiro Kawata
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Kohei Hosoda
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Akihiro Tamoto
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Yuichiro Ikebuchi
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Kazuya Matsumoto
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Koichiro Kawaguchi
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Kenichi Harada
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Yoshikazu Murawaki
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Faculty of Medicine, University of Tottori, Yonago 683-8504, Japan
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Yoshio T, Tsuchida T, Ishiyama A, Omae M, Hirasawa T, Yamamoto Y, Fujisaki J, Sato Y, Sasaki T, Kawabata K, Igarashi M. Efficacy of double-scope endoscopic submucosal dissection and long-term outcomes of endoscopic resection for superficial pharyngeal cancer. Dig Endosc 2017; 29:152-159. [PMID: 27525634 DOI: 10.1111/den.12712] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/12/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Owing to increased awareness and use of narrow-band imaging, there are more opportunities to treat superficial pharyngeal cancer (SPC). The present study aimed to describe the short- and long-term outcomes of endoscopic resection (ER) for SPC. METHODS This study included 166 consecutive SPC in 113 patients treated during 2006 to 2013 at one referral cancer center. In the first period, we treated patients using endoscopic mucosal resection (EMR), in the second period using conventional ESD (cESD) and in the recent period using double-scope ESD (dsESD), which involves a second thin endoscope for assistance to produce traction. Median follow-up period was 30 months. RESULTS All lesions were diagnosed as squamous cell carcinoma. Complete resection rate of cESD and dsESD procedures was 56.4% and 82.3% (P < 0.01), and local recurrence rate was 2.6% and 0.0%, respectively. Procedure duration was significantly shorter for dsESD than for cESD (P < 0.05). Four cases of recurrent lymph node (LN) metastasis were observed; however, all patients with LN metastases survived to a 48-month median interval after neck dissection. Risk factors for LN metastasis included subepithelium invasion, tumor thickness >1000 μm, droplet infiltration, and lymphovascular invasion. Overall survival rate after 5 years was 79.5%; no patients died of SPC. Cumulative rate of metachronous SPC after 5 years was 46.5%. CONCLUSION ER for SPC is a feasible and effective treatment, although metachronous SPC occurred frequently. For the technique of ER, dsESD was effective.
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Affiliation(s)
- Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masami Omae
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yorimasa Yamamoto
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yukiko Sato
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tohru Sasaki
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuyoshi Kawabata
- Department of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masahiro Igarashi
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Kawada K, Kawano T, Sugimoto T, Yamaguchi K, Kawamura Y, Matsui T, Okuda M, Ogo T, Kume Y, Nakajima Y, Mora A, Okada T, Hoshino A, Tokairin Y, Nakajima Y, Okada R, Kiyokawa Y, Nomura F, Asakage T, Shimoda R, Ito T. Case of Superficial Cancer Located at the Pharyngoesophageal Junction Which Was Dissected by Endoscopic Laryngopharyngeal Surgery Combined with Endoscopic Submucosal Dissection. Case Rep Otolaryngol 2017; 2017:1341059. [PMID: 28154766 PMCID: PMC5244026 DOI: 10.1155/2017/1341059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022] Open
Abstract
Aims. In order to determine the indications of transoral surgery for a tumor located at the pharyngoesophageal junction, the trumpet maneuver with transnasal endoscopy was used. Its efficacy is reported here. Material and Methods. An 88-year-old woman complaining of dysphagia, diagnosed with cervical esophageal cancer, and hoping to preserve her voice and swallowing function was admitted to our hospital. Conventional endoscopy showed that the tumor had invaded the hypopharynx. When inspecting the hypopharynx and the orifice of the esophagus, we asked the patient to blow hard and puff her cheeks with her mouth closed (trumpet maneuver). After the trumpet maneuver, the pharyngeal mucosa was stretched out. The pedicle of the tumor arose from the left-anterior wall of the pharyngoesophageal junction, so we decided to perform endoscopic resection. Result. Under general anesthesia, the curved laryngoscope made it possible to view the whole hypopharynx, including the apex of the piriform sinus and the orifice of the esophagus. The cervical esophageal cancer was pulled up to the hypopharynx. Under collaboration between a head and neck surgeon and an endoscopist, the tumor was resected en bloc by endoscopic laryngopharyngeal surgery combined with endoscopic submucosal dissection. Conclusion. Transnasal endoscopy using the trumpet maneuver is useful for a precise diagnosis of the pharyngoesophageal junction. Close collaboration between head and neck surgeons and endoscopists can provide good results in treating tumors of the pharyngoesophageal junction.
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Affiliation(s)
- Kenro Kawada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuyuki Kawano
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taro Sugimoto
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuya Yamaguchi
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuudai Kawamura
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshihiro Matsui
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masafumi Okuda
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taichi Ogo
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuuichiro Kume
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yutaka Nakajima
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Andres Mora
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuya Okada
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akihiro Hoshino
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yutaka Tokairin
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuaki Nakajima
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuhei Okada
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yusuke Kiyokawa
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Fuminori Nomura
- Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryo Shimoda
- Department of Internal Medicine and Gastrointestinal Endoscopy, Saga Medical School, Saga, Japan
| | - Takashi Ito
- Department of Human Pathology, Tokyo Medical and Dental University, Tokyo, Japan
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Minami H, Tabuchi M, Matsushima K, Akazawa Y, Yamaguchi N, Ohnita K, Takeshima F, Nakao K. Endoscopic submucosal dissection of the pharyngeal region using anchored hemoclip with surgical thread: A novel method. Endosc Int Open 2016; 4:E828-31. [PMID: 27540568 PMCID: PMC4988839 DOI: 10.1055/s-0042-108802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/02/2016] [Indexed: 01/29/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) of the pharyngeal region has not been well accepted, although ESD of the gastrointestinal tract is a standard procedure for treating early cancers. However, early detection and treatment of pharyngeal cancers is highly beneficial because surgical resection can be highly invasive and cause serious cosmetic deformities, swallowing disorders, dysgeusia, and speech defects. On the other hand, application of an anchored clip with surgical thread during ESD of the gastrointestinal tract has been reported to be beneficial. This pilot case series reveals the usefulness and clinical feasibility of applying a clip with thread in ESD of the pharyngeal region.
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Affiliation(s)
- Hitomi Minami
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital,Corresponding author Hitomi Minami, MD, PhD, FASGE Department of Gastroenterology and HepatologyNagasaki University Hospital1-7-1, SakamotoNagasaki, Japan, 8528501+81-95-819-7482
| | - Maiko Tabuchi
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital
| | - Kayoko Matsushima
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital
| | - Yuko Akazawa
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital
| | - Naoyuki Yamaguchi
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital
| | - Ken Ohnita
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital
| | - Fuminao Takeshima
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital
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30
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Mizushima T, Ohnishi S, Shimizu Y, Hatanaka Y, Hatanaka KC, Hosono H, Kubota Y, Natsuizaka M, Kamiya M, Ono S, Homma A, Kato M, Sakamoto N, Urano Y. Fluorescent imaging of superficial head and neck squamous cell carcinoma using a γ-glutamyltranspeptidase-activated targeting agent: a pilot study. BMC Cancer 2016; 16:411. [PMID: 27387955 PMCID: PMC4936014 DOI: 10.1186/s12885-016-2421-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 06/16/2016] [Indexed: 01/11/2023] Open
Abstract
Background Detecting superficial head and neck squamous cell carcinoma (HNSCC) by endoscopy is challenging because of limited morphological hallmarks, and iodine cannot be applied to head and neck lesions due to severe mucosal irritation. γ-glutamyltranspeptidase (GGT), a cell surface enzyme, is overexpressed in several cancers, and it has been reported that γ-glutamyl hydroxymethyl rhodamine green (gGlu-HMRG), a fluorescent targeting agent which can be enzymatically activated and becomes fluorescent after cleavage of a GGT-specific sequence, can be activated within a few minutes after application to animal models. We investigated whether early HNSCC can be detected by applying gGlu-HMRG to clinical samples. Methods gGlu-HMRG was applied to four HNSCC cell lines, and fluorescence was observed by fluorescence microscopy and flow cytometry. Immunohistological examination was performed in three recent cases of endoscopic submucosal dissection (ESD) to investigate GGT expression. Fluorescence imaging with gGlu-HMRG in eight clinical samples resected by ESD or surgery was performed, and fluorescence intensity of tumor and normal mucosa regions of interest (ROI) was prospectively measured. Results All four gGlu-HMRG-applied cell lines emitted green fluorescence. Immunohistological examination demonstrated that GGT was highly expressed in HNSCC of the recent three ESD cases but barely in the normal mucosa. Fluorescence imaging showed that iodine-voiding lesions became fluorescent within a few minutes after application of gGlu-HMRG in all eight resected tumors. Tumor ROI fluorescence intensity was significantly higher than in the normal mucosa five minutes after gGlu-HMRG application. Conclusions Fluorescence imaging with gGlu-HMRG would be useful for early detection of HNSCC.
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Affiliation(s)
- Takeshi Mizushima
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Shunsuke Ohnishi
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yuichi Shimizu
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yutaka Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Hidetaka Hosono
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yoshimasa Kubota
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Mitsuteru Natsuizaka
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Mako Kamiya
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shouko Ono
- Division of Endoscopy, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Mototsugu Kato
- Division of Endoscopy, Hokkaido University Hospital, N14, W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, N15, W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Yasuteru Urano
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Japan Agency for Medical Research and Development (AMED)-CREST, 7-1 Ootemachi-1, Chiyoda-ku, Tokyo, 100-0004, Japan
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31
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Onoyama H, Kamiya M, Kuriki Y, Komatsu T, Abe H, Tsuji Y, Yagi K, Yamagata Y, Aikou S, Nishida M, Mori K, Yamashita H, Fujishiro M, Nomura S, Shimizu N, Fukayama M, Koike K, Urano Y, Seto Y. Rapid and sensitive detection of early esophageal squamous cell carcinoma with fluorescence probe targeting dipeptidylpeptidase IV. Sci Rep 2016; 6:26399. [PMID: 27245876 PMCID: PMC4887889 DOI: 10.1038/srep26399] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/29/2016] [Indexed: 12/25/2022] Open
Abstract
Early detection of esophageal squamous cell carcinoma (ESCC) is an important prognosticator, but is difficult to achieve by conventional endoscopy. Conventional lugol chromoendoscopy and equipment-based image-enhanced endoscopy, such as narrow-band imaging (NBI), have various practical limitations. Since fluorescence-based visualization is considered a promising approach, we aimed to develop an activatable fluorescence probe to visualize ESCCs. First, based on the fact that various aminopeptidase activities are elevated in cancer, we screened freshly resected specimens from patients with a series of aminopeptidase-activatable fluorescence probes. The results indicated that dipeptidylpeptidase IV (DPP-IV) is specifically activated in ESCCs, and would be a suitable molecular target for detection of esophageal cancer. Therefore, we designed, synthesized and characterized a series of DPP-IV-activatable fluorescence probes. When the selected probe was topically sprayed onto endoscopic submucosal dissection (ESD) or surgical specimens, tumors were visualized within 5 min, and when the probe was sprayed on biopsy samples, the sensitivity, specificity and accuracy reached 96.9%, 85.7% and 90.5%. We believe that DPP-IV-targeted activatable fluorescence probes are practically translatable as convenient tools for clinical application to enable rapid and accurate diagnosis of early esophageal cancer during endoscopic or surgical procedures.
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Affiliation(s)
- Haruna Onoyama
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.,Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Mako Kamiya
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.,PRESTO, Japan and Science and Technology Agency, 4-1-8 Honcho, Kawaguchi, Saitama, 332-0012, Japan
| | - Yugo Kuriki
- Laboratory of Chemistry and Biology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Toru Komatsu
- PRESTO, Japan and Science and Technology Agency, 4-1-8 Honcho, Kawaguchi, Saitama, 332-0012, Japan.,Laboratory of Chemistry and Biology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yosuke Tsuji
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yukinori Yamagata
- Department of surgery, Dokkyo Medical University Koshigaya Hospital, 343-8555 2-1-50 Minami-Koshigaya, Koshigaya city, Saitama, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masato Nishida
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazuhiko Mori
- Mitsui Memorial Hospital, 1 Kanda-Izumi-cho, Chiyoda-ku, Tokyo 101-8643, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Sachiyo Nomura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Nobuyuki Shimizu
- Sanno Hospital, International University of Health and Welfare, 8-10-16, Akasaka, Minato-ku, Tokyo 107-0052, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yasuteru Urano
- Laboratory of Chemical Biology and Molecular Imaging, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.,Laboratory of Chemistry and Biology, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.,AMED-CREST, Japan Agency for Medical Research and Development, 1-7-1 Otemachi, Chiyoda-ku, Tokyo, 100-0004, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Odagiri H, Iizuka T, Kikuchi D, Kaise M, Takeda H, Ohashi K, Yasunaga H. Gastrointestinal Endoscopy-Assisted Minimally Invasive Surgery for Superficial Cancer of the Uvula. Clin Endosc 2016; 49:289-93. [PMID: 27040382 PMCID: PMC4895940 DOI: 10.5946/ce.2015.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 01/27/2023] Open
Abstract
Previous studies reported that endoscopic resection is effective for the treatment of superficial pharyngeal cancers, as for digestive tract cancers. However, the optimal treatment for superficial cancer of the uvula has not been established because of the rarity of this condition. We present two male patients in their 70s with superficial cancer of the uvula, detected with upper gastrointestinal endoscopy. Both patients underwent surgical resection of the uvula under general anesthesia. The extent of the lesions was determined by means of gastrointestinal endoscopy by using magnifying observation with narrow-band imaging, enabling the performance of minimally invasive surgery. Endoscopic submucosal dissection was performed to achieve en bloc resection of the intramucosal carcinoma that had infiltrated the area adjacent to the uvula. Gastrointestinal endoscopists should carefully examine the laryngopharynx to avoid missing superficial cancers. Our minimally invasive treatment for superficial cancer of the uvula had favorable postoperative outcomes, and prevented postoperative loss of breathing, swallowing, and articulation functions.
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Affiliation(s)
- Hiroyuki Odagiri
- Department of Gastroenterology, Saiseikai Kawaguchi General Hospital, Saitama, Japan.,Department of Clinical Epidemiology and Health Economics, The University of Tokyo School of Public Health, Tokyo, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Mitsuru Kaise
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Hidehiko Takeda
- Department of Otolaryngology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo School of Public Health, Tokyo, Japan
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33
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Tateya I, Shiotani A, Satou Y, Tomifuji M, Morita S, Muto M, Ito J. Transoral surgery for laryngo-pharyngeal cancer - The paradigm shift of the head and cancer treatment. Auris Nasus Larynx 2015; 43:21-32. [PMID: 26298233 DOI: 10.1016/j.anl.2015.06.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/26/2015] [Accepted: 06/22/2015] [Indexed: 12/11/2022]
Abstract
Transoral surgery is a less invasive treatment that is becoming a major strategy in the treatment of laryngo-pharyngeal cancer. It is a minimally invasive approach that has no skin incision and limits the extent of tissue dissection, disruption of speech and swallowing muscles, blood loss, damage to major neurovascular structures, and injury to normal tissue. Transoral approaches to the laryngo-pharynx, except for early glottis cancer, had been limited traditionally to tumors that can be observed directly and manipulated with standard instrumentation and lighting. Since the 1990s, transoral laser microsurgery (TLM) has been used as an organ preservation strategy with good oncological control and good functional results, although it has not been widely used because of its technical difficulty. Recently, transoral robotic surgery (TORS) is becoming popular as a new treatment modality for laryngo-pharyngeal cancer, and surgical robots are used widely in the world since United States FDA approval in 2009. In spite of the global spread of TORS, it has not been approved by the Japan FDA, which has led to the development of other low-cost transoral surgical techniques in Japan. Transoral videolaryngoscopic surgery (TOVS) was developed as a new transoral surgery system for laryngo-pharyngeal lesions to address the problems of TLM. In TOVS, a rigid endoscope is used to visualize the surgical field instead of a microscope and the advantages of TOVS include the wide operative field and working space achieved using the distending laryngoscope and videolaryngoscope. Also, with the spread of narrow band imaging (NBI), endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), which are widely used for superficial cancers in the gastrointestinal tract, have been applied for the superficial laryngo-pharyngeal cancer. Both EMR and ESD are performed mainly by gastroenterologists with a sharp dissector and magnifying endoscopy (ME)-NBI with minimal surgical margin. Endoscopic laryngo-pharyngeal surgery (ELPS) was developed to treat laryngo-pharyngeal superficial cancer by modifying the ESD procedure. The concept of ELPS is the same as that of ESD, however, the resection procedure is performed by a head and neck surgeon with both hands using a ME-NBI and rigid curved laryngo-pharyngoscope. These four procedures are low cost with similar oncological and functional outcomes to TORS. TORS may be less expensive than chemoradiotherapy, but the number of hospitals that can afford da Vinci surgical systems is limited. Even in the era of robotic surgery, these four procedures will be good options for laryngo-pharyngeal cancer.
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Affiliation(s)
- Ichiro Tateya
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Japan.
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Japan
| | - Yasuo Satou
- Department of Otolaryngology, Tachikawa Hospital, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Japan
| | - Shuko Morita
- Department of Gastroenterology, Kobe City Medical Center General Hospital, Japan
| | - Manabu Muto
- Department of Clinical Oncology, Graduate School of Medicine, Kyoto University, Japan
| | - Juichi Ito
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Japan; Shiga Medical Center Research Institute, Japan
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Kinjo Y, Nonaka S, Oda I, Abe S, Suzuki H, Yoshinaga S, Maki D, Yoshimoto S, Taniguchi H, Saito Y. The short-term and long-term outcomes of the endoscopic resection for the superficial pharyngeal squamous cell carcinoma. Endosc Int Open 2015; 3:E266-73. [PMID: 26357670 PMCID: PMC4554513 DOI: 10.1055/s-0034-1392094] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/17/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Early detection of superficial pharyngeal squamous cell carcinoma (SPSCC) using narrow-band imaging as well as the increasing use of ER for gastrointestinal cancers may increase the number of ER for SPSCC. The aims of this study were to clarify the feasibility of ER for SPSCC and its long-term outcomes. PATIENTS AND METHODS In total, 84 patients with 115 lesions were treated by endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) between March 2004 and August 2012. We retrospectively assessed the en bloc and R0 resection rates, complications, lymph node metastasis (LNM), local recurrence, metachronous pharyngeal and esophageal SCC, 5-year overall and cause-specific survival rates. RESULTS Higher proportions of en bloc and R0 resection were achieved with ESD compared to EMR (en bloc 100 % vs. 60 %, P < 0.001; R0 59 % vs. 26 %, P < 0.005). There were no significant complications in both groups. None of the patients died from primary SPSCC during the median follow-up of 34 months (range, 3 - 115). LNM occurred in three patients and local recurrence was detected in seven patients (8.3 %) with eight lesions. Tumor thickness over 1000 μm (P < 0.005) and positive or inconclusive horizontal margins (P < 0.05) were significant risk factors for LNM and local recurrence, respectively. Twelve patients died because of co-existing clinical conditions. The 5-year overall and cause-specific survival rates were 80.7 % and 100 %, respectively. CONCLUSIONS ER for SPSCC is a feasible treatment with promising results. Tumor thickness over 1000 μm is a significant risk factor for LNM and positive or inconclusive horizontal margin is a risk factor for local recurrence.
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Affiliation(s)
- Yuzuru Kinjo
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Daisuke Maki
- Head and Neck Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Head and Neck Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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35
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Endoscopic laryngo-pharyngeal surgery for superficial laryngo-pharyngeal cancer. Surg Endosc 2015; 30:323-9. [PMID: 25917165 DOI: 10.1007/s00464-015-4213-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/08/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND STUDY AIMS Narrow band imaging (NBI) combined with magnifying endoscopy enables us to detect superficial laryngo-pharyngeal cancers, which are difficult to detect by standard endoscopy. Endoscopic laryngo-pharyngeal surgery (ELPS) is a technique developed to treat such lesions and the purpose of this study is to evaluate the usefulness of ELPS for superficial laryngo-pharyngeal cancer. PATIENTS AND METHODS Seventy five consecutive patients with 104 fresh superficial laryngo-pharyngeal cancers are included in this study. Under general anesthesia, a specially-designed curved laryngoscope was inserted to create a working space in the pharyngeal lumen. A magnifying endoscope was inserted transorally to visualize the field and a head & neck surgeon dissected the lesion using the combination of the orally-inserted curved grasping forceps and electrosurgical needle knife in both hands. The safely, functional outcomes, and oncologic outcomes of ELPS were evaluated retrospectively. RESULTS Median operation time per lesion was 35 min. Post-operative bleeding occurred in 3 cases and temporal subcutaneous emphysema occurred in 10 cases. No vocal fold impairment occurred after surgery. The median fasting period was 2 days and all patients except one have a normal diet with no limitations. Local recurrence occurred in 1 case, and the 3-year overall survival rate and the 3-year disease specific survival rate was 90% and 100%, respectively. CONCLUSIONS ELPS is a hybrid of head and neck surgery and gastrointestinal endoscopic treatment, and enjoys the merit of both procedures. ELPS makes it possible to perform minimally-invasive surgery, preserving both the swallowing and phonation functions.
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Kikuchi D, Iizuka T, Yamada A, Furuhata T, Yamashita S, Nomura K, Kuribayashi Y, Kimura R, Matsui A, Mitani T, Ogawa O, Takeda H, Hoteya S, Kaise M. Utility of magnifying endoscopy with narrow band imaging in determining the invasion depth of superficial pharyngeal cancer. Head Neck 2014; 37:846-50. [DOI: 10.1002/hed.23683] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 12/18/2013] [Accepted: 03/07/2014] [Indexed: 12/16/2022] Open
Affiliation(s)
- Daisuke Kikuchi
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | - Toshiro Iizuka
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | - Akihiro Yamada
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | | | | | - Kosuke Nomura
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | | | - Ryuusuke Kimura
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | - Akira Matsui
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | | | - Osamu Ogawa
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | - Hidehiko Takeda
- Department of Otorhinolaryngology; Toranomon Hospital; Tokyo Japan
| | - Shu Hoteya
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
| | - Mitsuru Kaise
- Department of Gastroenterology; Toranomon Hospital; Tokyo Japan
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Goda K, Dobashi A, Tajiri H. Perspectives on narrow-band imaging endoscopy for superficial squamous neoplasms of the orohypopharynx and esophagus. Dig Endosc 2014; 26 Suppl 1:1-11. [PMID: 24372999 DOI: 10.1111/den.12220] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/01/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Narrow-band imaging (NBI) is widely available and over the last decade has been applied as a detection and characterization technique for superficial neoplasms of the aerodigestive tract. The aims of the present study were to systematically review clinical trials of NBI endoscopy and to investigate an upgraded NBI system using a novel endoscope for superficial squamous neoplasms in the orohypopharynx and esophagus. METHODS Studies on the diagnostic use of NBI endoscopy for superficial squamous neoplasms in the orohypopharynx and esophagus were retrieved from MEDLINE and PubMed and reviewed. An upgraded NBI system using a novel endoscope was investigated with our clinical cases. RESULTS In many clinical trials, NBI endoscopy with or without magnification had high diagnostic value for superficial squamousneoplasms in the orohypopharynx and esophagus. An upgraded NBI system can produce a significantly brighter endoscopic view than conventional endoscopes with high-quality magnified images that could be used to diagnose superficial squamous neoplasms. CONCLUSIONS NBI endoscopy with or without magnification has diagnostic utility for superficial squamous neoplasms in the orohypopharynx and esophagus. The upgraded NBI endoscopic system is expected to facilitate the use of NBI and magnifying endoscopic diagnosis.
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Affiliation(s)
- Kenichi Goda
- Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan
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Suzuki T, Ikeda H, Iwamoto T, Sano H, Hashimoto M, Oe K, Inoue H, Serada K. Elective use of an uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway. Can J Anaesth 2013; 61:39-45. [PMID: 24158854 DOI: 10.1007/s12630-013-0057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/10/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To conduct a qualitative observational study on positive pressure ventilation through a percutaneous uncuffed small-bore cricothyrotomy tube with balloon occlusion of the subglottic airway to minimize supraglottic leak. CLINICAL FEATURES Ten consecutive procedures were performed in the nine men enrolled in this study. The demographics of the participants were: aged 50-73 yr, weight 48-87 kg, American Society of Anesthesiologists class I-II, and scheduled for endoscopic submucosal dissection via flexible endoscopy for en bloc resection of superficial meso- and hypopharyngeal cancer. The airway was initially secured with a supraglottic airway (SGA) under sevoflurane-based anesthesia, and a cricothyrotomy was then performed using a Portex(®) Minitrach II uncuffed cricothyrotomy tube (4-mm internal diameter). Following SGA removal, a Coopdech(®) bronchial blocker was orally or nasally inserted, and the balloon was inflated to occlude the trachea immediately beneath the glottis. The ventilator setting was initially based on observation of chest motion and end-tidal carbon dioxide tension and then readjusted according to arterial blood gas levels. All procedures were completed within a median time of 149 min. Effective ventilation was achieved in all patients despite mild hypercapnia (PaCO2 of 58 mmHg at maximum) in some patients. SpO2 levels were maintained at ≥ 98%. CONCLUSION This technique provides effective intraoperative ventilation and easy endoscopic access, and it countermeasures against the likely complication of postoperative laryngeal edema. Moreover, there is no need for conventional tracheostomy or prolonged intubation. This approach establishes a curative and less invasive pharyngeal cancer therapy. Certain adverse outcomes can be avoided, including impaired speech and swallowing, possible delayed closure of the stoma, or a compromised cosmetic outcome.
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Affiliation(s)
- Takashi Suzuki
- Department of Anesthesia, Showa University Northern Yokohama Hospital, 35-1 Chigasaki-Chuo, Tsuzuki-ku, Yokohama, 224-8503, Japan,
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Hochberger J, Köhler P, Kruse E, Hûppertz J, Delvaux M, Gay G, Wedi E. [Endoscopic submucosal dissection]. Internist (Berl) 2013; 54:287-301. [PMID: 23455659 DOI: 10.1007/s00108-012-3179-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Endoscopic submucosal dissection (ESD) was developed in Japan but has now also become permanently established in various centers in Europe. ESD is an endoscopic en bloc mucosal resection technique for the treatment of early cancers with a diameter >1 cm and also superficial precancerous lesions, which could only be removed unsatisfactorily in several fragments or with uncertain lateral safety margins using previous loop excision procedures. Using ESD a lesion is excised after circular marking and generous submucosal injection with a safety margin of approximately 5 mm and subsequently resected at the level of the submucosa with a 1-3 mm short diathermic knife. ESD requires high technical skills in interventional endoscopy and is more time-consuming than snare resection techniques. However, numerous studies have shown a clear superiority for ESD with respect to the R0 resection rate and the local recurrence rate. The present article gives a current review of the use of ESD in the upper and lower gastrointestinal tract and demonstrates perspectives of the procedure.
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Affiliation(s)
- J Hochberger
- Sérvice de Gastroentérologie, Hôpitaux Universitaires de Strasbourg - NHC, 1 Place de l'Hôpital, 67000, Strasbourg (Cedex), Frankreich.
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Shimizu Y, Takahashi M, Yoshida T, Ono S, Mabe K, Kato M, Asaka M, Hatanaka K, Sakamoto N. Endoscopic in vivo cellular imaging of superficial squamous cell carcinoma of the head and neck by using an integrated endocytoscopy system (with video). Gastrointest Endosc 2013; 78:351-8. [PMID: 23660562 DOI: 10.1016/j.gie.2013.03.1336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recently, some patients have been found to have superficial squamous cell carcinoma (SCC) of the head and neck region during GI endoscopy; however, endoscopic biopsy from a lesion in the head and neck region is troublesome. An endocytoscopy system has been reported to enable optical biopsy of an esophageal lesion. OBJECTIVE To evaluate the feasibility of in vivo cellular imaging with an integrated endocytoscopy system for patients with superficial SCC of the head and neck. DESIGN Experimental pilot study. SETTING University hospital. PATIENTS This study involved 12 patients who were found to have superficial SCC of the head and neck during GI endoscopy. INTERVENTION Endocytoscopic images were taken of each lesion and of the surrounding mucosa. The images were later reviewed by 1 pathologist and 2 endoscopists who were unaware of any other findings. MAIN OUTCOME MEASUREMENTS Correlation between endocytoscopy diagnosis and histologic diagnosis. RESULTS Adequate endocytoscopic images could be obtained in 11 of the 12 patients (15 of 16 lesions). For endocytoscopic images of 15 lesions and 12 areas of surrounding mucosa, the overall accuracy of endocytoscopic diagnosis in differentiating between nonmalignant and malignant histopathology by the pathologist, endoscopist 1, and endoscopist 2 were 96%, 96%, and 96%, respectively. The kappa value for interobserver agreement was 0.77. LIMITATIONS Single-center experience, small number of patients. CONCLUSION An endocytoscopy system has the potential to be used as an optical biopsy for superficial head and neck lesions.
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Affiliation(s)
- Yuichi Shimizu
- Department of Gastroenterology, Hokkaido University Hospital, Sapporo, Japan
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Emura F, Baron TH, Gralnek IM. The pharynx: examination of an area too often ignored during upper endoscopy. Gastrointest Endosc 2013; 78:143-9. [PMID: 23582474 DOI: 10.1016/j.gie.2013.02.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 02/14/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Fabian Emura
- Advanced Gastrointestinal Endoscopy, EmuraCenter LatinoAmerica, Emura Foundation for the Promotion of Cancer Research Medical School, Universidad de La Sabana, Bogota, Colombia
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Tsuboi M, Arai M, Maruoka D, Matsumura T, Nakagawa T, Katsuno T, Yokosuka O. Utility of unsedated transnasal endoscopy for pharyngeal observation during esophagogastroduodenoscopy. A prospective study to assess cardiopulmonary function. Scand J Gastroenterol 2013; 48:884-9. [PMID: 23731392 DOI: 10.3109/00365521.2013.800989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Emergence of image-enhanced endoscopy has enabled an early detection of pharyngeal carcinoma. Pharyngeal observation during esophagogastroduodenoscopy (EGD) is sometimes difficult because of excessive reflexes and is a great burden to the patients and impacts on their cardiopulmonary function. In this study, the authors aimed to evaluate the utility of transnasal EGD (TN-EGD) in comparison with sedated and unsedated transoral EGD (TO-EGD) in pharyngeal observation using a continuous monitoring device. METHODS A total of 70 patients receiving diagnostic EGD (unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD) were enrolled in this study and were evaluated by the following three criteria: (1) numbers of patients with excessive gag and/or cough reflex, (2) vital signs before and during the pharyngeal observation, and (3) response to the request for vocalization or breath-holding. RESULTS Unsedated TN-EGD, sedated TO-EGD, and unsedated TO-EGD were performed in 30, 20, and 20 patients, respectively. The rate of gag reflex was significantly lower in TN-EGD than in both types of TO-EGD (0% vs. 30%, chi-square test, p < 0.005). The changes in average values of both arterial oxygen saturation (SpO2) and pulse rate (PR) in TN-EGD were smaller than those in sedated TO-EGD (-0.23% vs. -1.23% in SpO2 and 1.57 vs. 8.11 bpm in PR, p < 0.01, respectively). Unsedated TN-EGD patients could respond to the instructions of utterance and breath-holding during the observation (p < 0.05, p < 0.001, respectively). CONCLUSION Unsedated TN-EGD is safe and feasible for pharyngeal observation during normal EGD examination.
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Affiliation(s)
- Masaru Tsuboi
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Feasibility of a "resect and watch" strategy with endoscopic resection for superficial pharyngeal cancer. Gastrointest Endosc 2013; 78:22-9. [PMID: 23540439 DOI: 10.1016/j.gie.2013.01.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 01/31/2013] [Indexed: 01/29/2023]
Abstract
BACKGROUND After endoscopic resection (ER) for superficial pharyngeal cancer (SPC), additional treatments such as radical surgical resection or radiation therapy may be needed in cases of possible incomplete resection. However, the benefit of prophylactic additional treatment is unclear. OBJECTIVE To evaluate the feasibility of a "resect and watch" strategy with ER for SPC. DESIGN Retrospective, single-center cohort study. SETTING Tertiary cancer center. PATIENTS A total of 32 patients with 47 SPCs were eligible. INTERVENTION A "resect and watch" strategy of initial ER and observation until development of secondary diseases, including local recurrence, neck lymph node metastasis (LNM), and metachronous pharyngeal cancer. MAIN OUTCOME MEASUREMENTS Complications, tumor recurrence, development of metachronous pharyngeal cancer, overall survival, and cause-specific survival. RESULTS There were no severe complications related to ER. Median length of follow-up was 43 months (range, 7-76 months). Cumulative development of secondary diseases at 5 years was 44% (95% CI, 24.5%-63.8%). Local recurrence (N = 4) and neck LNM (N = 5) were successfully treated by local resection (2 partial surgical resections and 2 additional ERs) and neck dissection, respectively. Metachronous pharyngeal cancers (N = 6) were completely removed by ER. The overall survival and cause-specific survival rates at 5 years were 84.4% (95% CI, 70.0%-98.8%) and 100%, respectively. No patient needed radical surgery as an additional therapy. Thus, the larynx and its function were preserved in all patients. LIMITATIONS Retrospective nature, single-center setting, relatively small sample size. CONCLUSIONS A "resect and watch" strategy with ER for SPC is feasible and rational.
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Nakayama M, Katada C, Mikami T, Okamoto M, Koizumi W, Tanabe S, Miyamoto S, Okamoto T, Seino Y, Kano K. A Clinical Study of Transoral Pharyngectomies to Treat Superficial Hypopharyngeal Cancers. Jpn J Clin Oncol 2013; 43:782-7. [DOI: 10.1093/jjco/hyt081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shimizu Y, Takahashi M, Yoshida T, Ono S, Mabe K, Kato M, Asaka M, Sakamoto N. What is an adequate management strategy for pharyngeal low-grade dysplasia? Gastrointest Endosc 2013; 77:972-3. [PMID: 23684094 DOI: 10.1016/j.gie.2012.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 12/15/2012] [Indexed: 02/08/2023]
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Kuwabara T, Hiyama T, Oka S, Urabe Y, Tanaka S, Yoshihara M, Arihiro K, Shimamoto F, Chayama K. Response. Gastrointest Endosc 2013; 77:973-4. [PMID: 23684095 DOI: 10.1016/j.gie.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 12/11/2022]
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Kikuchi O, Ezoe Y, Morita S, Horimatsu T, Muto M. Narrow-band Imaging for the Head and Neck Region and the Upper Gastrointestinal Tract. Jpn J Clin Oncol 2013; 43:458-65. [DOI: 10.1093/jjco/hyt042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Bok GH, Cho WY, Cho JY, Jin SY, Ahn JH, Chun CG, Lee TH, Kim HG. Endoscopic resection of hypopharyngeal squamous cell carcinoma. Clin Endosc 2013; 46:189-92. [PMID: 23614132 PMCID: PMC3630316 DOI: 10.5946/ce.2013.46.2.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 01/30/2023] Open
Abstract
Hypopharyngeal cancers are often diagnosed at an advanced stage and have a poor prognosis. Even when they are diagnosed at an operable stage, surgery often results in substantial morbidity and decreased patients' quality of life. Although the endoscopic diagnosis of early hypopharyngeal cancer is difficult, recent developments in advanced imaging endoscopy have enabled easier diagnosis of these lesions. Endoscopic resection of early hypopharyngeal cancer is a potential minimally invasive treatment that can preserve the function and quality of life of patients. Reports of this procedure are limited, however. We report a case of hypopharygeal cancer treated with endoscopic resection.
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Affiliation(s)
- Gene Hyun Bok
- Gastrointestinal Cancer Center, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Ono S, Kato M, Nakagawa M, Imai A, Yamamoto K, Shimizu Y. Outcomes and predictive factors of "not self-completion" in gastric endoscopic submucosal dissection for novice operators. Surg Endosc 2013; 27:3577-83. [PMID: 23549768 DOI: 10.1007/s00464-013-2929-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/08/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) has become the standard endoscopic treatment for gastric neoplasms because of its safety and high rate of curability; however, it is not easy for novice operators to learn the technique of ESD. In this study, predictive factors of gastric neoplasms in which novices could not finish ESD by self-completion were evaluated. METHODS Eighty consecutive ESD procedures performed by four novice operators were retrospectively analyzed. Standard ESD procedures were performed using an insulation-tipped (IT) knife under supervision. Self-completion rates, procedure time, and complete resection rates were evaluated, and predictive factors for "not self-completion" were assessed. RESULTS The overall self-completion rate and en bloc plus R0 resection rate were 87.5% (70/80) and 95.7 % (67/70), respectively. In "not self-completion" cases (n = 10), the procedure time was longer and resected specimens were larger than those in self-completion cases (83.7 ± 47.3 min vs. 189.5 ± 106.8 min, p < 0.05; 641.2 ± 487.8 vs. 1,116 ± 480.4 mm(2), p < 0.01). Predictive factors of "not self-completion" were tumor location in the middle or upper third of the stomach or in the greater curvature and size of resected specimens larger than 900 mm(2). The self-completion rate of ESD was decreased in cases with more than two predictive factors. CONCLUSIONS For novice operators, tumor location and resected areas are predictive factors for failure to finish gastric ESD by self-completion. Selection of cancer lesions could be a key factor for effectiveness of ESD training.
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Affiliation(s)
- Shouko Ono
- Division of Endoscopy, Hokkaido University Hospital, Nishi-7, Kita-15, Kita-ku, Sapporo, 060-8638, Japan,
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Takahashi M, Shimizu Y, Yoshida T, Mori Y, Nakagawa M, Yamamoto J, Ono S, Nakagawa S, Mabe K, Kudo T, Kato M, Asaka M. A case of oropharyngeal squamous papilloma in which endoscopic resection was performed. Gastrointest Endosc 2012; 76:1270-1. [PMID: 22365440 DOI: 10.1016/j.gie.2012.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 01/03/2012] [Indexed: 02/08/2023]
Affiliation(s)
- Masakazu Takahashi
- Third Department of Internal Medicine, Hokkaido University Hospital, Sapporo, Japan
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