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Qu JY, Li Y, Liu GQ, Li Z, Zhong N, Zhang MM, Li YY, Yu T, Lu XF, Li LX, Liu H, Qi QQ, Li YQ, Zuo XL. Optimal concentration of Lugol's solution for detecting early esophageal carcinoma: A randomized controlled trial. J Gastroenterol Hepatol 2023. [PMID: 37094943 DOI: 10.1111/jgh.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/11/2022] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM Lugol chromoendoscopy is the standard technique to detect an esophageal squamous cell carcinoma (ESCC). However, a high concentration of Lugol's solution can induce mucosal injury and adverse events. We aimed to investigate the optimal concentration of Lugol's solution to reduce mucosal injury and adverse events without degrading image quality. METHODS This was a two-phase double-blind randomized controlled trial. In phase I, 200 eligible patients underwent esophagogastroduodenoscopy and then were randomly (1:1:1:1:1) sprayed with 1.2%, 1.0%, 0.8%, 0.6%, or 0.4% Lugol's solution. Image quality, gastric mucosal injury, adverse events, and operation satisfaction were compared to investigate the minimal effective concentration. In phase II, 42 cases of endoscopic mucosectomy for early ESCC were included. The patients were randomly assigned (1:1) to the minimal effective (0.6%) or conventional (1.2%) concentration of Lugol's solution for further comparison of the effectiveness. RESULTS In phase I, the gastric mucosal injury was significantly reduced in 0.6% group (P < 0.05). Furthermore, there was no statistical significance in image quality between 0.6% and higher concentrations of Lugol's solution (P > 0.05, respectively). It also showed that the operation satisfaction decreased in 1.2% group compared with the lower concentration groups (P < 0.05). In phase II, the complete resection rate was 100% in both groups, while 0.6% Lugol's solution showed higher operation satisfaction (W = 554.500, P = 0.005). CONCLUSIONS The study indicates that 0.6% might be the optimal concentration of Lugol's solution for early detection and delineation of ESCC, considering minimal mucosal injury and satisfied image. The registry of clinical trials: ClinicalTrials.gov (NCT03180944).
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Affiliation(s)
- Jun-Yan Qu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Guan-Qun Liu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhen Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ning Zhong
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ming-Ming Zhang
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yue-Yue Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tao Yu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xue-Feng Lu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Li-Xiang Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Han Liu
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qing-Qing Qi
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI tumor, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Su F, Zhu M, Feng R, Li Y. ME-NBI combined with endoscopic ultrasonography for diagnosing and staging the invasion depth of early esophageal cancer: a diagnostic meta-analysis. World J Surg Oncol 2022; 20:343. [PMID: 36253783 PMCID: PMC9575268 DOI: 10.1186/s12957-022-02809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background Several methods can assist in detecting early esophageal cancer (EEC) and staging esophageal cancer (EC) invasion depth. Objective To evaluate the accuracy of magnifying endoscopy with narrow-band imaging (ME-NBI) plus endoscopic ultrasonography (EUS) for diagnosing EC. Methods We searched the PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant studies. The Quality Assessment of Diagnostic Accuracy Studies 2 (QADAS2) was used to assess the studies’ methodological quality. The sensitivity, specificity, positive likelihood (LR+), negative likelihood (LR−), and diagnostic odds ratio (DOR) were calculated, and the summary receiver operating characteristic (SROC) curves were drawn to evaluate the diagnostic performance. Results Seven studies were included. The meta-analysis suggested that the pooled sensitivity, specificity, LR+, LR−, and DOR of ME-NBI plus EUS for diagnosing EC were 0.947 (95% confidence interval [CI], 0.901–0.975), 0.894 (95% CI, 0.847–0.931), 7.989 (95% CI, 4.264–14.970), 0.066 (95% CI, 0.035–0.124), and 137.96 (95% CI, 60.369–315.27), respectively. Those values for staging the invasive depth were 0.791 (95% CI, 0.674–0.881), 0.943 (95% CI, 0.906–0.968), 13.087 (95% CI, 7.559–22.657), 0.226 (95% CI, 0.142–0.360), and 61.332 (95% CI, 27.343–137.57). The areas under the curves (AUCs) for diagnosis and staging were 0.97 and 0.95, respectively. Conclusions ME-NBI plus EUS might be an adequate diagnostic and staging modality for EC. Due to the study limitations, more large-scale, high-quality studies are needed to confirm the diagnostic accuracy of ME-NBI plus EUS. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02809-6.
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Affiliation(s)
- Feng Su
- Department of Gastroenterology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Hospital of Nanjing Drum Tower Hospital Group, Suqian, Jiangsu Province, 223800, China
| | - Meiling Zhu
- Department of Gastroenterology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Hospital of Nanjing Drum Tower Hospital Group, Suqian, Jiangsu Province, 223800, China
| | - Ru Feng
- Department of Gastroenterology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Hospital of Nanjing Drum Tower Hospital Group, Suqian, Jiangsu Province, 223800, China
| | - Yunhong Li
- Department of Gastroenterology, The Affiliated Suqian Hospital of Xuzhou Medical University, Suqian Hospital of Nanjing Drum Tower Hospital Group, Suqian, Jiangsu Province, 223800, China.
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Guo Q, Fan X, Zhu S, Zhao X, Fang N, Guo M, Liu Z, Han Y. Comparing N-acetylcysteine with sodium thiosulfate for relieving symptoms caused by Lugol's iodine chromoendoscopy: a randomized, double-blind trial. Gastrointest Endosc 2022; 95:249-257. [PMID: 34371004 DOI: 10.1016/j.gie.2021.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/30/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Lugol's iodine chromoendoscopy is an important method to detect esophageal squamous cell carcinoma. Sodium thiosulfate solution (STS) has been used to neutralize iodine after Lugol's chromoendoscopy; however, it is not available in many medical centers. The aim of the current study was to assess the efficacy of N-acetylcysteine solution (NAC) for relieving symptoms caused by Lugol's iodine chromoendoscopy. METHODS Patients were randomized to receive either STS or NAC after spraying Lugol's iodine solution on the esophagus. The neutralizing effects for residual iodine in the esophagus and gastric mucous pool were observed. The primary endpoint was the intensity of retrosternal pain and/or heartburn measured by a visual analog scale (VAS) score 30 minutes after chromoendoscopy. Secondary endpoints were the rate of patients with any adverse symptom, rate of moderate to severe retrosternal discomfort occurring, and heart rate variability between time points before and after chromoendoscopy. RESULTS The neutralization rates for residual iodine between the NAC and STS groups were not significantly different (P > .999). The difference of median VAS scores between the NAC and STS groups 30 minutes after chromoendoscopy was .0 (P = .719; 95% confidence interval, .0-.0), and the 95% confidence interval higher limit was .0, which was less than our prespecified margin of .5, concluding an noninferiority of NAC with regard to STS. There was no significant difference between the 2 groups regarding the rate of patients with any adverse symptom, rate of moderate to severe retrosternal discomfort, or heart rate variability at 5 minutes or 30 minutes after chromoendoscopy. CONCLUSION As a very easily accessible reagent in clinical circumstances, NAC can also alleviate mucosal irritation symptoms induced by Lugol's chromoendoscopy at similar efficacy as STS and can be routinely recommended. (Clinical trial registration number: NCT04764643.).
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Affiliation(s)
- Quan Guo
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Xiaotong Fan
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Shaohua Zhu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Xin Zhao
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Na Fang
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Meng Guo
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Zhiguo Liu
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
| | - Ying Han
- Xijing Hospital of Digestive Diseases, Air Force Medical University (Fourth Military Medical University), Xian, China
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Kim SH, Hong SJ. Current Status of Image-Enhanced Endoscopy for Early Identification of Esophageal Neoplasms. Clin Endosc 2021; 54:464-476. [PMID: 34304482 PMCID: PMC8357583 DOI: 10.5946/ce.2021.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Advanced esophageal cancer is known to have a poor prognosis. The early detection of esophageal neoplasms, including esophageal dysplasia and early esophageal cancer, is highly important for the accurate treatment of the disease. However, esophageal dysplasia and early esophageal cancer are usually subtle and can be easily missed. In addition to the early detection, proper pretreatment evaluation of the depth of invasion of esophageal cancer is very important for curative treatment. The progression of non-invasive diagnosis via image-enhanced endoscopy techniques has been shown to aid the early detection and estimate the depth of invasion of early esophageal cancer and, as a result, may provide additional opportunities for curative treatment. Here, we review the advancement of image-enhanced endoscopy-related technologies and their role in the early identification of esophageal neoplasms.
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Affiliation(s)
- Shin Hee Kim
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Department of Biostatistics, Soonchunghyang University School of Medicine, Bucheon, Korea
| | - Su Jin Hong
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Department of Biostatistics, Soonchunghyang University School of Medicine, Bucheon, Korea
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Singh R, Chiam KH, Leiria F, Pu LZCT, Choi KC, Militz M. Chromoendoscopy: role in modern endoscopic imaging. Transl Gastroenterol Hepatol 2020; 5:39. [PMID: 32632390 DOI: 10.21037/tgh.2019.12.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/04/2019] [Indexed: 12/17/2022] Open
Abstract
Detection of early gastrointestinal tract malignancy can be challenging on white light endoscopy especially as lesions can be subtle and inconspicuous. With the advent of electronic chromoendoscopy technologies, lesions which have already been detected can be quickly and "conveniently" characterised. This review will discuss some of the indications and modern applications of chromoendoscopy in various conditions including Barrett's oesophagus, oesophageal squamous cell carcinoma, early gastric cancer, inflammatory bowel disease and neoplastic colonic lesions. In carefully selected situations, chromoendoscopy could still be a useful adjunct to white light endoscopy in day-to-day clinical practice.
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Affiliation(s)
- Rajvinder Singh
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia.,Faculty of Health Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Keng Hoong Chiam
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Florencia Leiria
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Leonardo Zorron Cheng Tao Pu
- Faculty of Health Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.,Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kun Cheong Choi
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Mariana Militz
- Gastroenterology Department, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
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Fan M, Meng L, Shi H, Wang W, Han C, Hou X, Ding Z, Lin R. Exploration of a new intrapapillary capillary loop classification in diagnosis of superficial esophageal squamous cell carcinoma staging: a meta-analysis and single-center study. J Cancer Res Clin Oncol 2020; 146:1479-1488. [PMID: 32236686 DOI: 10.1007/s00432-020-03199-6] [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: 12/22/2019] [Accepted: 03/24/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Though intrapapillary capillary loops (IPCL) can be used to diagnose the staging of superficial esophageal squamous cell carcinoma (SESCC), the accuracy still remains controversial. Moreover, which IPCL classification is more suitable for clinical application is unclear. The aim was to evaluate the diagnostic performance of different IPCL classifications and to explore a new classification. PATIENTS AND METHODS A meta-analysis was conducted to compare the diagnostic efficiency of the three IPCL classifications for SESCC staging. STATA 12.0 software was used and bivariate mixed effects-model was applied for the meta-analysis. A new classification was developed based on the meta-analysis result. Then a single-center study was conducted for further validation analysis. RESULTS Of the 2310 citations, 14 studies fulfilled our criteria. For epithelium (EP) and lamina propria mucosa (LPM) staging tumors, IPCL showed high diagnostic accuracy (Inoue: 87.17%, Arima: 98.71%, JES: 86.70%). For muscularis mucosa (MM) and submucosa (SM1), 23.12% were underestimated and the Japan Esophageal Society classification (JES) was better than Inoue (Accuracy: 75.48% VS 58.67%, P < 0.05). For ≥ SM2, 38.86% were underdiagnosed and the diagnostic accuracy of Arima classification was significantly higher than the other two (P < 0.05). Our study showed that the new criteria had higher diagnostic sensitivity than the widely used classification (JES) for differentiating ≥ SM2 staging cancer from EP-SM1 (0.77 VS 0.50, P < 0.05). CONCLUSIONS IPCL was valuable for diagnosing SESCC staging. However, ≥ MM would be underestimated easily. Our study revealed that the diagnostic sensitivity for ≥ SM2 staging tumors was significantly improved by the new standard.
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Affiliation(s)
- Mengke Fan
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Lingjun Meng
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Huiying Shi
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Weijun Wang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Chaoqun Han
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Xiaohua Hou
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Zhen Ding
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China
| | - Rong Lin
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei Province, China.
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Abstract
Endoscopic resection for early esophageal cancer is a very precise endoscopic surgical technique and having experience in endoscopic resection is mandatory to perform these kinds of procedures safely. In case of adequate resection and favorable histological outcome, long-term prognosis of the patient is excellent. The basic principle for endoscopic treatment of early adenocarcinoma is based on the fact that the risk of lymph node metastasis gradually increases with the depth of invasion. Inspection and evaluation of all mucosal and submucosal lesions need to be done carefully before endoscopic resection. Endoscopic resection of mucosal (T1m1-3) and superficial submucosal (T1sm1) adenocarcinoma can be curative as well as for superficial mucosal (T1m1-m2) squamous cell carcinoma. In Paris type I lesions in Barrett's esophagus and for early squamous cell carcinoma endoscopic submucosal dissection (ESD) is the preferred option. The risk of severe adverse events associated with endoscopic resection are low. Most adverse events are managed endoscopically and can be treated conservatively. Endoscopic radiofrequency ablation is the most widely used ablation technique for Barrett's epithelium and highly effective to achieve full remission of dysplasia and intestinal metaplasia. The role of radiofrequency ablation in the treatment armamentarium in squamous cell carcinoma of the esophagus has still to be determined.
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Affiliation(s)
- Irma C Noordzij
- Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - Wouter L Curvers
- Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik J Schoon
- Department of Gastroenterology and Hepatology, Catharina Cancer Institute, Catharina Hospital, Eindhoven, The Netherlands
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Reichenbach ZW, Murray MG, Saxena R, Farkas D, Karassik EG, Klochkova A, Patel K, Tice C, Hall TM, Gang J, Parkman HP, Ward SJ, Tétreault MP, Whelan KA. Clinical and translational advances in esophageal squamous cell carcinoma. Adv Cancer Res 2019; 144:95-135. [PMID: 31349905 DOI: 10.1016/bs.acr.2019.05.004] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is among the most deadly forms of human malignancy characterized by late stage diagnosis, metastasis, therapy resistance and frequent recurrence. Clinical management of ESCC remains challenging and the disease presently lacks approved targeted therapeutics. However, emerging data from recent clinical and translational investigations hold great promise for future progress toward improving patient outcomes in this deadly disease. Here, we review current clinical perspectives in ESCC epidemiology, pathophysiology, and clinical care, highlighting recent advances with potential to impact ESCC prevention, diagnosis and management. We further provide an overview of recent translational investigations contributing to our understanding of the molecular mechanisms underlying ESCC development, progression and therapy response, including insights gained from genetic studies and various murine model systems. Finally, we discuss future perspectives in the clinical and translational realms, along with remaining hurdles that must be overcome to eradicate ESCC.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Medicine, Gastroenterology Section, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States; Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Mary Grace Murray
- Fels Institute for Cancer Research & Molecular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Reshu Saxena
- Fels Institute for Cancer Research & Molecular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Daniel Farkas
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Erika G Karassik
- Fels Institute for Cancer Research & Molecular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Alena Klochkova
- Fels Institute for Cancer Research & Molecular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Kishan Patel
- Fels Institute for Cancer Research & Molecular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Caitlin Tice
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States
| | - Timothy M Hall
- Fels Institute for Cancer Research & Molecular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Julie Gang
- Fels Institute for Cancer Research & Molecular Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Henry P Parkman
- Department of Medicine, Gastroenterology Section, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Sarah J Ward
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States; Department of Pharmacology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Marie-Pier Tétreault
- Department of Medicine, Gastroenterology and Hepatology Division, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - Kelly A Whelan
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States; Department of Pathology & Laboratory Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
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9
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Li J, Xu R, Liu M, Cai H, Cao C, Liu F, Li F, Guo C, Pan Y, He Z, Ke Y. Lugol Chromoendoscopy Detects Esophageal Dysplasia With Low Levels of Sensitivity in a High-Risk Region of China. Clin Gastroenterol Hepatol 2018; 16:1585-1592. [PMID: 29174712 DOI: 10.1016/j.cgh.2017.11.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/14/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Chromoendoscopy with Lugol dye is used to screen for early-stage esophageal squamous dysplasia (ESD) and esophageal cancer. However, the sensitivity with which Lugol chromoendoscopy detects ESD or esophageal cancer has not been fully assessed in large populations in China. METHODS From 2012 to 2016, a total of 15,264 residents in rural Hua County, Henan Province, which is a high-incidence area of esophageal cancer in China, were screened by Lugol chromoendoscopy. Biopsies were collected from endoscopically visualized lesions, identified before and after Lugol chromoendoscopy, and analyzed histologically. Biopsies were also collected from standard sites in the esophagus (28 and 33 cm distal to the incisors) if no abnormalities were found. We calculated the sensitivity with which Lugol chromoendoscopy detects esophageal dysplasia and carcinoma, using findings from biopsy analysis as the reference standard. RESULTS A total 586 participants were found by biopsy analysis to have ESD or more severe lesions. After endoscopy images were reviewed twice, Lugol chromoendoscopy sensitivity values for the detection of mild, moderate, and severe dysplasia, and esophageal cancer, were 45.9%, 55.3%, 87.0%, and 97.7%, respectively. ESDs were most frequently missed by Lugol chromoendoscopy in younger patients and men with moderate levels of dysplasia. CONCLUSION In a screening analysis of a general population in China, we found Lugol chromoendoscopy to identify individuals with ESD with lower levels of sensitivity (46%-87%) than previously believed, although it identified patients with esophageal cancer with almost 98% sensitivity. Prospective studies are needed to evaluate the clinical significance of esophageal lesions that are not detected by endoscopy.
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Affiliation(s)
- Jingjing Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Ruiping Xu
- Anyang Cancer Hospital, Anyang, Henan Province, P.R. China
| | - Mengfei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Hong Cai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Changqi Cao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Endoscopy Center, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Fangfang Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Fenglei Li
- Hua County People's Hospital, Henan Province, P.R. China
| | - Chuanhai Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Yaqi Pan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China
| | - Zhonghu He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China.
| | - Yang Ke
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Laboratory of Genetics, Peking University Cancer Hospital and Institute, Beijing, P.R. China.
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Mansour NM, Anandasabapathy S. Lugol's Chromoendoscopy in the Screening of Esophageal Squamous Cell Carcinoma: Time to Take a Closer Look? Clin Gastroenterol Hepatol 2018; 16:1562-1563. [PMID: 29857149 DOI: 10.1016/j.cgh.2018.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/01/2018] [Accepted: 05/21/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Nabil M Mansour
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Sharmila Anandasabapathy
- Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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11
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Ponds FA, Moonen A, Smout AJPM, Rohof WOA, Tack J, van Gool S, Bisschops R, Bredenoord AJ, Boeckxstaens GE. Screening for dysplasia with Lugol chromoendoscopy in longstanding idiopathic achalasia. Am J Gastroenterol 2018; 113:855-862. [PMID: 29748564 DOI: 10.1038/s41395-018-0064-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Achalasia patients with longstanding disease are considered to be at risk for developing esophageal cancer. Endoscopic screening is not standardized and detection of dysplastic lesions is difficult, for which Lugol chromoendoscopy could be helpful. Aim was to evaluate the efficacy of screening for esophageal dysplasia and carcinoma in patients with longstanding achalasia using Lugol chromoendoscopy. METHODS In this cohort study achalasia patients underwent three-annual screening by Lugol chromoendoscopy between January 2000 and March 2016. Patients with low-grade dysplasia (LGD) underwent yearly screening, patients with high-grade dysplasia (HGD) or carcinoma were treated. RESULTS In total, 230 achalasia patients (144 male, median age 52 years (IQR 43-63) at first endoscopy) were included. Three patients (1.3%, 2 male, age 68 years (range 50-87)) developed esophageal squamous cell carcinoma (ESCC), without LGD at the preceding screening. Incidence rate for ESCC was 63 (95% CI 13-183) per 100 000 persons-years. LGD was observed in 4 patients (1.7%, 2 male, age 64 years (range 57-73)), without progression to HGD/ESCC during a follow-up of 9 (IQR 7-14) years. ESCC/LGD was diagnosed 30 (IQR 14-36) years after onset of symptoms and 22 (IQR 4-13) years after diagnosis. Lugol chromoendoscopy tripled the detection rate of suspected lesions (111 lesions white light versus 329 lesions Lugol), but only 8% was histopathological confirmed ESCC or LGD. CONCLUSION Achalasia patients with longstanding disease (>20 years) have an increased risk to develop esophageal dysplasia and carcinoma. Endoscopic screening using white light and Lugol chromoendoscopy does not accurately identify precursor lesions for ESCC and therefore cannot be systematically recommended.
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Affiliation(s)
- Fraukje A Ponds
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - An Moonen
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - André J P M Smout
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - Wout O A Rohof
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - Jan Tack
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - Stijn van Gool
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
| | - Guy E Boeckxstaens
- Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Department of Gastroenterology and hepatology, University hospital Leuven, KU Leuven, Leuven, Belgium
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12
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Yu T, Geng J, Song W, Jiang Z. Diagnostic Accuracy of Magnifying Endoscopy with Narrow Band Imaging and Its Diagnostic Value for Invasion Depth Staging in Esophageal Squamous Cell Carcinoma: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8591387. [PMID: 29888281 PMCID: PMC5985084 DOI: 10.1155/2018/8591387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/25/2018] [Accepted: 04/08/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND GOALS This study aimed to investigate the diagnostic accuracy of magnifying endoscopy with narrow band imaging (ME-NBI) and determine its value for invasion depth staging in esophageal squamous cell carcinoma. METHODS We searched the PubMed, Embase, and Cochrane Library databases and found relevant studies published up to December 2016. Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the quality of the studies. We calculated sensitivity, specificity, and positive and negative likelihood values from forest plots and determined summary receiver operating characteristic (sROC) curves for ME-NBI diagnostic accuracy analysis. RESULTS Ten studies met our criteria and were selected for this meta-analysis. A total of 1,033 patients underwent ME-NBI, and 207 of these patients received a diagnosis of staging mucosal or submucosal invasion. The pooled sensitivity, specificity, and positive and negative likelihood values of ME-NBI for the diagnostic rate were 0.90 (95% CI, 0.71-0.97), 0.90 (95% CI, 0.80-0.95), 6.74 (95% CI, 3.52-712.89), and 0.20 (95% CI, 0.10-0.42), respectively. The area under the curve (AUC) was 0.95 for all studies. CONCLUSIONS ME-NBI provides a high diagnostic rate in evaluating the esophagus to diagnose squamous cell carcinoma. In the differentiation for invasion depth staging, ME-NBI was demonstrated to be superior to white light endoscopy and had a similar diagnostic rate compared with HF-EUS. However, HF-EUS had high positive likelihood values for invasion depth staging, suggesting that HF-EUS is a reliable method for confirming invasion depth staging.
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Affiliation(s)
- Tingting Yu
- Department of Gastroenterology Center, The No. 1 People's Hospital of Yancheng, Yancheng 224000, China
| | - Jin Geng
- Department of Cardiology, Huai'an First People's Hospital, Huai'an 223001, China
| | - Wei Song
- Department of Gastroenterology Center, Huai'an First People's Hospital, Nanjing Medical University, Huai'an 223001, China
| | - Zhonghua Jiang
- Department of Gastroenterology Center, The No. 1 People's Hospital of Yancheng, Yancheng 224000, China
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13
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Simões CA, Durazzo MD, de Aquino Xavier FC, Gallottini MHC, Lourenço SV, Pinto Júnior DDS, Magacho de Andrade NM, Miazaki AP, Dedivitis RA, Cernea CR. Lugol Chromoscopy in the Follow-up of Head and Neck Carcinoma. Ann Maxillofac Surg 2017; 7:188-193. [PMID: 29264284 PMCID: PMC5717893 DOI: 10.4103/ams.ams_95_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Lugol is helpful in identifying early second primary tumors (SPTs) during oroscopy and pharyngoscopy, but this technique has not been assessed during follow-up visits with these patients. Aim: The aim of this study is to describe the use of Lugol (a low-cost method) to diagnose SPTs in the oral cavity and oropharynx. Methods: Patients treated for squamous cell carcinoma of the head and neck were randomly assigned to two groups. Group A was examined with routine oroscopy and pharyngoscopy without Lugol, and Group B was examined with routine oroscopy and pharyngoscopy without stain and with Lugol. A total of 211 patients were included during 4 years. Results: Six oral and oropharynx carcinomas were detected in Group A. Eighteen oral and oropharynx carcinomas were detected in Group B, twelve of which were not seen without chromoscopy but were detected with Lugol. Conclusion: Lugol increases the detection of malignant lesions compared to routine examination alone.
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Affiliation(s)
- Cesar Augusto Simões
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Marcelo Doria Durazzo
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | | | | | | | | | - Aline Paterno Miazaki
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Rogério Aparecido Dedivitis
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Cláudio Roberto Cernea
- Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil
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Roshandel G, Khoshnia M, Sotoudeh M, Merat S, Etemadi A, Nickmanesh A, Norouzi A, Pourshams A, Poustchi H, Semnani S, Ghasemi-Kebria F, Noorbakhsh R, Abnet C, Dawsey SM, Malekzadeh R. Endoscopic screening for precancerous lesions of the esophagus in a high risk area in Northern Iran. ARCHIVES OF IRANIAN MEDICINE 2015; 17:246-52. [PMID: 24724600 DOI: 014174/aim.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) is a major health problem in many developing countries including Iran. ESCC has a very poor prognosis, largely due to late diagnosis. As a first step in developing an early detection and treatment program, we conducted a population-based endoscopic screening for ESCC and its precursor lesion, esophageal squamous dysplasia (ESD) in asymptomatic adults from Golestan Province, northern Iran, a high-risk area for ESCC, to evaluate the feasibility of such a program and to document the prevalence and risk factor correlates of ESD. METHODS This cross-sectional study was conducted among participants of the Golestan Cohort Study (GCS), a population-based cohort of 50,000 adults in eastern Golestan Province. Randomly selected GCS participants were invited by telephone. Those who accepted were referred to a central endoscopy clinic. Eligible subjects were consented and then asked to fill in a brief questionnaire. Detailed information about selected risk factors was obtained from the GCS main database. Endoscopic examination with Lugol's iodine staining was performed, biopsies were taken from unstained lesions as well as the normally stained mucosa of the esophagus, and the biopsies were diagnosed by expert pathologists according to previously described criteria. RESULTS In total, 1906 GCS subjects were invited, of whom only 302 subjects (15.8%) were successfully enrolled. Esophagitis (29.5%) and ESD (6.0%) were the most common pathological diagnoses. Turkmen ethnicity (adjusted OR = 8.61; 95%CI: 2.48-29.83), being older than the median age (OR = 7.7; 95% CI: 1.99-29.87), and using deep frying cooking methods (OR = 4.65; 95%CI: 1.19-18.22) were the strongest predictors for ESD. There were significant relationships between esophagitis and smoking (p-value<0.001), drinking hot tea (P value = 0.02) and lack of education (P value = 0.004). CONCLUSION We observed a low rate for participation in endoscopic screening. Overall prevalence of ESD was 6.0%. Developing non-endoscopic primary screening methods and screening individuals with one or more risk factors may improve these rates.
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Affiliation(s)
- Gholamreza Roshandel
- 1)Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2)Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan,
| | - Masoud Khoshnia
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoud Sotoudeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Merat
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- 1)Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 3)Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Arash Nickmanesh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Norouzi
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahryar Semnani
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Fatemeh Ghasemi-Kebria
- Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roya Noorbakhsh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Christian Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Coda S, Thillainayagam AV. State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract. Clin Exp Gastroenterol 2014; 7:133-50. [PMID: 24868168 PMCID: PMC4028486 DOI: 10.2147/ceg.s58157] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Ideally, endoscopists should be able to detect, characterize, and confirm the nature of a lesion at the bedside, minimizing uncertainties and targeting biopsies and resections only where necessary. However, under conventional white-light inspection – at present, the sole established technique available to most of humanity – premalignant conditions and early cancers can frequently escape detection. In recent years, a range of innovative techniques have entered the endoscopic arena due to their ability to enhance the contrast of diseased tissue regions beyond what is inherently possible with standard white-light endoscopy equipment. The aim of this review is to provide an overview of the state-of-the-art advanced endoscopic imaging techniques available for clinical use that are impacting the way precancerous and neoplastic lesions of the gastrointestinal tract are currently detected and characterized at endoscopy. The basic instrumentation and the physics behind each method, followed by the most influential clinical experience, are described. High-definition endoscopy, with or without optical magnification, has contributed to higher detection rates compared with white-light endoscopy alone and has now replaced ordinary equipment in daily practice. Contrast-enhancement techniques, whether dye-based or computed, have been combined with white-light endoscopy to further improve its accuracy, but histology is still required to clarify the diagnosis. Optical microscopy techniques such as confocal laser endomicroscopy and endocytoscopy enable in vivo histology during endoscopy; however, although of invaluable assistance for tissue characterization, they have not yet made transition between research and clinical use. It is still unknown which approach or combination of techniques offers the best potential. The optimal method will entail the ability to survey wide areas of tissue in concert with the ability to obtain the degree of detailed information provided by microscopic techniques. In this respect, the challenging combination of autofluorescence imaging and confocal endomicroscopy seems promising, and further research is awaited.
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Affiliation(s)
- Sergio Coda
- Section of Gastroenterology and Hepatology, Department of Medicine and Photonics Group, Department of Physics, Imperial College London, London, UK ; Endoscopy Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew V Thillainayagam
- Section of Gastroenterology and Hepatology, Department of Medicine and Photonics Group, Department of Physics, Imperial College London, London, UK ; Endoscopy Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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16
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Urquhart P, DaCosta R, Marcon N. Endoscopic mucosal imaging of gastrointestinal neoplasia in 2013. Curr Gastroenterol Rep 2013; 15:330. [PMID: 23771504 DOI: 10.1007/s11894-013-0330-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The holy grail of gastrointestinal endoscopy consists of the detection, in vivo characterization, and endoscopic removal of early or premalignant mucosal lesions. While our ability to achieve this goal has improved substantially since the development of the modern video-endoscope, inadequate visual inspection, errors of interpretation, and lesion subtlety all contribute to the continued suboptimal detection and assessment of early neoplasia. A myriad of new technologies has thus emerged that may help resolve these shortcomings; high magnification endoscopes, as well as the techniques of dye-based and virtual chromoendoscopy, are now widely available, while confocal laser endomicroscopy and endocystoscopy, optical coherence tomography, and autofluorescence imaging are generally applicable only in a research setting. Such technologies can be broadly categorized according to whether they potentially afford endoscopists improved detection, or real-time characterization, of mucosal lesions. Enhanced detection of otherwise "invisible" lesions, such as a flat area of intramucosal adenocarcinoma within Barrett's esophagus, carries the potential of an endoscopic cure prior to the development into a more advanced or metastatic disease. The ability to characterize a lesion to achieve an in vivo diagnosis, such as a colonic polyp, potentially affords endoscopists the ability to decide which lesions require removal and which can be safely left behind or discarded without histological assessment. Furthermore targeted biopsies, such as in the surveillance of chronic colitis, may prove to be more accurate and efficacious than the current protocol of random biopsies. An important caveat in the discussion of developing technologies in early cancer detection is the fundamental importance of a health-care system that promotes screening programs to recruit at-risk individuals. The ideal tool to optimize the use of endoscopy in population screening would be a panel of reliable biomarkers (blood, stool, or urine) that could effectively select a high-risk group, thus reducing the indiscriminate use of an expensive technology. The following review summarizes the current endoscopic imaging techniques available, and in development, for the early identification of gastrointestinal neoplasia.
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Affiliation(s)
- P Urquhart
- St Michael's Hospital, Toronto, ON, Canada
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17
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Initial staging of squamous cell carcinoma of the oral cavity, larynx and pharynx (excluding nasopharynx). Part 2: Remote extension assessment and exploration for secondary synchronous locations outside of the upper aerodigestive tract. 2012 SFORL guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:107-12. [DOI: 10.1016/j.anorl.2012.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 09/13/2012] [Accepted: 09/15/2012] [Indexed: 11/19/2022]
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Lecleire S, Antonietti M, Iwanicki-Caron I, Duclos A, Lemoine F, Pessot FL, Michel P, Ducrotté P, Di Fiore F. Lugol chromo-endoscopy versus narrow band imaging for endoscopic screening of esophageal squamous-cell carcinoma in patients with a history of cured esophageal cancer: a feasibility study. Dis Esophagus 2011; 24:418-22. [PMID: 21309914 DOI: 10.1111/j.1442-2050.2010.01164.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
To date, Lugol chromo-endoscopy is the reference technique to detect an esophageal neoplasia in patients with prior esophageal squamous-cell carcinoma (ESCC), but is not easy to perform without general anesthesia, which can limit its use in routine practice. The objective of this study were to compare the accuracy of white light, narrow band imaging (NBI), and Lugol to detect esophageal neoplasia in patients with a history of cured ESCC, in a prospective study. Thirty patients were prospectively included between June 2006 and June 2009. They all had a history of cured ESCC. Esophageal mucosa was examined first using white light, second NBI, and third after Lugol staining. Histology was obtained in all abnormalities detected by white light, NBI, and/or Lugol. Five neoplastic lesions in five different patients were identified at histology, four cancers, and one high-grade dysplasia. NBI and Lugol both detected all esophageal neoplastic lesions, whereas white light detected the four cancers but missed the high-grade dysplasia. In this feasibility study, NBI and Lugol both detected all identified esophageal neoplasia in very high-risk patients of ESCC. This result suggests that NBI could be used instead of Lugol to detect an esophageal neoplasia in patients with high risk of ESCC, but needs to be confirmed in a larger study.
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Affiliation(s)
- S Lecleire
- Gastroenterology Department, Digestive Endoscopy Unit, Rouen University Hospital, France.
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Peng G, Long Q, Wu Y, Zhao J, Chen L, Li X. Evaluation of double vital staining with lugol's iodine and methylene blue in diagnosing superficial esophageal lesions. Scand J Gastroenterol 2011; 46:406-13. [PMID: 21189106 DOI: 10.3109/00365521.2010.545829] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate the accuracy of double vital staining with lugol's iodine and methylene blue in the diagnosis of superficial esophageal lesions. METHODS Doubtful superficial esophageal lesions identified with conventional endoscope were sprayed with 3% lugol's iodine and 0.5% methylene blue in order and observed in detail after each staining. Depending on the mucosal staining, biopsy specimen was obtained and underwent pathological examination. RESULTS Using conventional endoscope, we found 356 lesions in 297 patients, among which 179 were esophageal squamous cell carcinoma and precancerous lesions (CAPs) (including 71 early esophageal squamous cell carcinoma, 23 esophageal high-grade intraepithelial neoplasias, 85 esophageal low-grade intraepithelial neoplasias) and 177 were non-cancer non-precancerous lesions (NCNPs) (i.e. esophagitis and esophageal squamous cell hyperplasia). Most of CAPs were lightly stained or unstained, while NCNPs were hyperstained after lugol's iodine stained. The specificity, sensitivity, positive predictive value, negative predictive value and accuracy of lugol's lightly stained and unstained for identifying CAPs were 34.5%, 100%, 60.7%, 100% and 67.4%, respectively. Most of CAPs were lightly stained or hyperstained, while NCNPs were unstained after double vital staining. The specificity, sensitivity, positive predictive value, negative predictive value and accuracy of double vital staining lightly stained and hyperstained for identifying CAPs were 97.7%, 100%, 97.8%, 100% and 98.9%, respectively. The accuracy of double vital staining for identifying CAPs was higher than that of lugol's iodine stained (p = 0.000). CONCLUSION The double staining with lugol's iodine and methylene blue significantly improves the detection and diagnosis of early esophageal squamous cell CAPs.
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Affiliation(s)
- Guiyong Peng
- Gastroenterology Research Center, Southwest Hospital, Third Military Medical University, Chongqing, China.
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Choi IS, Jang JY, Cho WY, Lee TH, Kim HG, Lee BY, Jeong SW, Cho JY, Lee JS, Jin SY. Usefulness of magnifying endoscopy for iodine-unstained lesions in a high-risk esophageal cancer population. World J Gastroenterol 2010; 16:4709-15. [PMID: 20872973 PMCID: PMC2951523 DOI: 10.3748/wjg.v16.i37.4709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the usefulness of magnified observations of iodine-unstained esophageal lesions in the histological diagnosis of esophageal mucosa abnormalities, in high-risk esophageal cancer groups.
METHODS: The subjects included 38 patients who had at least one of the four criteria known to be high-risk factors for esophageal cancer. Following endoscopic observation, magnified observations were performed on iodine-unstained lesions of the esophagus. The total number of lesions was 43. These lesions were classified as type A (clear papilla), type B (fused papilla), and type C (non-visible papilla) according to the findings. Tissue biopsy was then carried out. Finally the histological findings were graded in terms of histological factors, and their relationships were compared.
RESULTS: Of the 43 lesions, 11 were type A, 17 were type B, and 15 were type C under magnifying endoscopy. Histological findings such as inflammatory cell infiltration and basal cell hyperplasia were significantly increased in type B and type C lesions compared with type A lesions (P < 0.05). Low-grade esophageal dysplasia was apparent in 1 (9%) of 11 type A lesions, in 3 (18%) of 17 type B lesions, and in 6 (40%) of 15 type C lesions, with the highest rate in type C.
CONCLUSION: Magnified observations of the esophagus, classified by papillary aspects using magnifying endoscopy of iodine-unstained lesions in high-risk esophageal cancer groups, are considered useful in estimating dysplasia and inflammation of esophageal mucosa.
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Chung CS, Lee YC, Wang CP, Ko JY, Wang WL, Wu MS, Wang HP. Secondary prevention of esophageal squamous cell carcinoma in areas where smoking, alcohol, and betel quid chewing are prevalent. J Formos Med Assoc 2010; 109:408-21. [PMID: 20610142 DOI: 10.1016/s0929-6646(10)60072-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Esophageal cancer is ranked as the sixth most common cause of cancer death worldwide and has a substantial effect on public health. In contrast to adenocarcinoma arising from Barrett's esophagus in Western countries, the major disease phenotype in the Asia-Pacific region is esophageal squamous cell carcinoma which is attributed to the prevalence of smoking, alcohol, and betel quid chewing. Despite a multidisciplinary approach to treating esophageal cancer, the outcome remains poor. Moreover, field cancerization reveals that esophageal squamous cell carcinoma is closely linked with the development of head and neck cancers that further sub-optimize the treatment of patients. Therefore, preventive strategies are of paramount importance to improve the prognosis of this dismal disease. Since obstacles exist for primary prevention via risk factor elimination, the current rationale for esophageal cancer prevention is to identify high-risk groups at earlier stages of the disease, and encourage them to get a confirmatory diagnosis, prompt treatment, and intensive surveillance for secondary prevention. Novel biomarkers for identifying specific at-risk populations are under extensive investigation. Advances in image-enhanced endoscopy do not just substantially improve our ability to identify small precancerous or cancerous foci, but can also accurately predict their invasiveness. Research input from the basic sciences should be translated into preventive measures in order to decrease the disease burden of esophageal cancer.
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Affiliation(s)
- Chen-Shuan Chung
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Gastric mucosal changes caused by Lugol's iodine solution spray: endoscopic features of 64 cases on screening esophagogastroduodenoscopy. Gastroenterol Res Pract 2010; 2010:494195. [PMID: 20396664 PMCID: PMC2853081 DOI: 10.1155/2010/494195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 01/26/2010] [Accepted: 02/16/2010] [Indexed: 11/18/2022] Open
Abstract
AIM To clarify the endoscopic mucosal change of the stomach caused by Lugol's iodine solution spray on screening esophagogastroduodenoscopy (EGD). METHODS Sixty-four consecutive patients who underwent EGD for esophageal squamous cell carcinoma screening were included in this study. The records for these patients included gastric mucosa findings before and after Lugol's iodine solution was sprayed. The endoscopic findings of the greater curvature of the gastric body were retrospectively analyzed based on the following findings: fold thickening, exudates, ulcers, and hemorrhage. RESULTS Mucosal changes occurred after Lugol's solution spray totally in 51 patients (80%). Fold thickening was observed in all 51 patients (80%), and a reticular pattern of white lines was found on the surface of the thickened gastric folds found in 28 of the patients (44%). Exudates were observed in 6 patients (9%). CONCLUSION The gastric mucosa could be affected by Lugol's iodine; the most frequent endoscopic finding of this effect is gastric fold thickening, which should not be misdiagnosed as a severe gastric disease.
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Abstract
Chromoendoscopy involves the use of stains or dyes during endoscopy to improve the visualization and characterization of the gastrointestinal mucosa. Its main clinical application is the detection of dysplasia or early cancer of the gastrointestinal tract in individuals with pre-malignant conditions or hereditary and environmental factors that predispose them to cancer. The utility of chromoendoscopy has been mostly studied in squamous cell carcinoma of the esophagus, Barrett's esophagus, gastric cancer, colorectal polyps, and chronic ulcerative colitis. Although chromoendoscopy has been shown to be feasible and safe, several limitations have prevented its widespread use in endoscopy. Despite this, chromoendoscopy remains a useful adjunct to standard white light endoscopy in the visualization of mucosal lesions, which may potentially improve tissue diagnosis and impact patient care.
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Affiliation(s)
- Raquel E Davila
- VA North Texas Health Care System, University of Texas Southwestern Medical Center, Dallas, 75216, USA.
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Lee YC, Wang CP, Chen CC, Chiu HM, Ko JY, Lou PJ, Yang TL, Huang HY, Wu MS, Lin JT, Hsiu-Hsi Chen T, Wang HP. Transnasal endoscopy with narrow-band imaging and Lugol staining to screen patients with head and neck cancer whose condition limits oral intubation with standard endoscope (with video). Gastrointest Endosc 2009; 69:408-17. [PMID: 19019362 DOI: 10.1016/j.gie.2008.05.033] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 05/05/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Early detection of esophageal cancer in patients with head and neck cancers may alter treatment planning and improve survival. However, standard endoscopic screening is not feasible for some patients with tumor-related airway compromise or postirradiation trismus. OBJECTIVE To evaluate a novel, sequential approach by integrating ultrathin endoscopy with narrow-band imaging and Lugol chromoendoscopy. DESIGN Cross-sectional study. SETTING Single center in Taiwan. PATIENTS Forty-four consecutive patients with transoral difficulty screened for synchronous or metachronous esophageal cancer. MAIN OUTCOME MEASUREMENTS Sensitivity, specificity, and accuracy in the detection of mucosal high-grade neoplasia or invasive cancer. RESULTS Fifty-four endoscopic interpretations were obtained, and 11 mucosal high-grade neoplasia and 7 invasive cancers were confirmed by histology. The mean examination time was 19.4 minutes (range 7.9-35.2 minutes), and all patients tolerated the procedure well. Sensitivity, specificity, and accuracy (with 95% CI) were 55.6% (95% CI, 33.5%-75.6%), 97.2% (95% CI, 85.8%-99.3%), and 83.3% (95% CI, 71.2%-90.9%), respectively, for standard endoscopy; 88.9% (95% CI, 66.9%-96.6%), 97.2% (95% CI, 85.8%-99.3%), and 94.4% (95% CI, 84.9%-97.9%), respectively, with the adjunct of narrow-band imaging; and 88.9% (95% CI, 66.9%-96.6%), 72.2% (95% CI, 55.9%-84.1%), and 77.8% (95% CI, 64.9%-86.8%), respectively, with the adjunct of Lugol chromoendoscopy. When we integrated all interpretations on the basis of the sequential approach, the estimated probability of false-negative findings was 1.2% (95% CI, 0.1%-4.6%). LIMITATIONS Inherent shortcomings of ultrathin endoscopy, such as its resolution, light source, and lack of magnification. CONCLUSIONS The use of ultrathin endoscopy in a sequential approach for multimodal detection is feasible in patients with transoral difficulty and substantially increases the detection rate of synchronous or metachronous neoplasms.
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Affiliation(s)
- Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Division of Biostatistics, Taipei, Taiwan
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Curvers WL, Kiesslich R, Bergman JJGHM. Novel imaging modalities in the detection of oesophageal neoplasia. Best Pract Res Clin Gastroenterol 2008; 22:687-720. [PMID: 18656825 DOI: 10.1016/j.bpg.2008.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The prognosis of oesophageal neoplasia is dependent on the stage of the disease at the time of detection. Early lesions have an excellent prognosis in contrast to more advanced stages that usually have a dismal prognosis. Therefore, the early detection of these lesions is of the utmost importance. In recent years, several new techniques have been introduced to improve the endoscopic detection of early lesions. The most important improvement, in general, has been the introduction of high-resolution/high-definition endoscopy into daily clinical practice. The value of superimposing techniques such as chromoendoscopy, narrow band imaging and computed virtual chromoendoscopy onto high-resolution/high-definition endoscopy will have to be proven in randomised cross-over trials comparing these techniques with standard techniques. Important future adjuncts to white-light endoscopy serving as 'red-flag' techniques for the detection of early neoplasia may be broad field functional imaging techniques such as video autofluorescence endoscopy. In addition, real-time histopathology during endoscopy has become possible with endocytoscopy and confocal endomicroscopy. The clinical value of these techniques needs to be ascertained in the coming years.
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Affiliation(s)
- W L Curvers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.
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Kaltenbach T, Sano Y, Friedland S, Soetikno R. American Gastroenterological Association (AGA) Institute technology assessment on image-enhanced endoscopy. Gastroenterology 2008; 134:327-40. [PMID: 18061178 DOI: 10.1053/j.gastro.2007.10.062] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This document presents the official recommendations of the American Gastroenterological Association (AGA) Institute Technology Assessment on "Image-Enhanced Endoscopy." It was approved by the Clinical Practice and Economics Committee on August 3, 2007, and by the AGA Institute Governing Board September 27, 2007.
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Affiliation(s)
- Tonya Kaltenbach
- Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, California, USA
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Wong Kee Song LM, Adler DG, Chand B, Conway JD, Croffie JMB, Disario JA, Mishkin DS, Shah RJ, Somogyi L, Tierney WM, Petersen BT. Chromoendoscopy. Gastrointest Endosc 2007; 66:639-49. [PMID: 17643437 DOI: 10.1016/j.gie.2007.05.029] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kaneko K, Katagiri A, Konishi K, Kurahashi T, Ito H, Kumekawa Y, Yamamoto T, Muramoto T, Kubota Y, Nozawa H, Makino R, Kushima M, Imawari M. Study of p53 gene alteration as a biomarker to evaluate the malignant risk of Lugol-unstained lesion with non-dysplasia in the oesophagus. Br J Cancer 2007; 96:492-8. [PMID: 17285122 PMCID: PMC2360032 DOI: 10.1038/sj.bjc.6603582] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Mutations of the p53 gene are detected frequently in oesophageal dysplasia and cancer. It is unclear whether Lugol-unstained lesions (LULs) with non-dysplastic epithelium (NDE) are precursors of oesophageal squamous cell carcinoma (ESCC). To study the genetic alterations of NDE in the multistep process of oesophageal carcinogenesis, we determined the relationship between p53 mutations and LULs-NDE. Videoendoscopy with Lugol staining was performed prospectively in 542 oesophageal cancer-free subjects. Lugol-unstained lesions were detected in 103 subjects (19%). A total of 255 samples, including 152 LULs (NDE, 137; dysplasia, 15) and 103 paired samples of normal staining epithelium, were obtained from 103 subjects. After extraction of DNA and polymerase chain reaction analysis, direct sequencing method was applied to detect mutations of the p53 gene. The p53 mutation was detected in five of 137 samples with LULs-NDE (4%) and in five of 15 samples with dysplasia (33%). A hotspot mutation was found in 20% of LULs-NDE with p53 mutation and in 40% of dysplasia with p53 mutation. In contrast, no p53 mutations were found in 103 paired NDE samples with normal Lugol staining. In biopsy samples from oesophageal cancer-free individuals, the p53 missense mutations containing a hotspot mutation were found in NDE, which was identified as an LUL. These findings suggest that some LULs-NDE may represent the earliest state of oesophageal squamous cell carcinoma in Japanese individuals.
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Affiliation(s)
- K Kaneko
- Second Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.
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Marín R, Gil MV, Castellano MM, Alvarez C, Belda O. [A review of the clinical application of dyes in gastrointestinal chromoendoscopy, and their magistral formulation]. FARMACIA HOSPITALARIA 2006; 30:112-9. [PMID: 16796425 DOI: 10.1016/s1130-6343(06)73956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To review the drug compounding of dyes employed in chromoendoscopy, and their clinical effectiveness. METHOD A literature search in Medline, Cochrane Library, and Micromedex was carried out with the term chromoendoscopy as a keyword, and the search was then repeated for each dye found in association with the term endoscopy. A number of monographs, scientific journals, and references quoted in selected papers were also reviewed. Papers collected were then classified according to their methodology. RESULTS Ninety-six references were found, their original article being recovered for only 57 of these - 13 clinical trials, 21 case series, and 11 reviews. References were found for 7 dyes. Main indications, evidence of effectiveness, administration route, and drug formulation are described for each dye. CONCLUSIONS The number of papers involved is high, but their accessibility is limited. Evidence is overall scarce, but high in cases such as methylene blue for Barrett s esophagus, lugol in the detection of esophageal carcinoma, and indigo carmine for colonic hyperplastic polyp differentiation. Drug compounding is rather simple, but scarcely developed.
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Affiliation(s)
- R Marín
- Servicio de Farmacia, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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Abstract
The detection of early-stage neoplastic lesions in the upper GI tract is associated with improved survival and the potential for complete endoscopic resection that is minimally invasive and less morbid than surgery. Despite technological advances in standard white-light endoscopy, the ability of the endoscopist to reliably detect dysplastic and early cancerous changes in the upper GI tract remains limited. In conditions such as Barrett's oesophagus, practice guidelines recommend periodic endoscopic surveillance with multiple biopsies, a methodology that is hindered by random sampling error, inconsistent histopathological interpretation, and delay in diagnosis. Early detection may be enhanced by several promising diagnostic modalities such as chromoendoscopy, magnification endoscopy, and optical spectroscopic/imaging techniques, as these modalities offer the potential to identify in real-time lesions that are inconspicuous under conventional endoscopy. The combination of novel diagnostic techniques and local endoscopic therapies will provide the endoscopist with much needed tools that can considerably enhance the detection and management of early stage lesions in the upper GI tract.
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Affiliation(s)
- Louis-Michel Wong Kee Song
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st Street S.W., Rochester, MN 55905, USA.
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Ravich WJ. The color of reflux: confessions of a skeptic. Gastrointest Endosc 2005; 62:704-7. [PMID: 16246683 DOI: 10.1016/s0016-5107(05)00549-3] [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: 03/03/2005] [Accepted: 03/08/2005] [Indexed: 12/10/2022]
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Nicolás Pérez D, Quintero E, Parra Blanco A. Cribado del carcinoma escamoso de esófago en población de riesgo. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:337-46. [PMID: 15989816 DOI: 10.1157/13076352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Together with adenocarcinoma, epidermoid esophageal carcinoma is the most clinically important neoplasm of the esophagus. Because of the low incidence of epidermoid esophageal carcinoma in the general population, strategies for its early diagnosis are not a priority compared with other neoplasms. However, because survival is low when the disease is diagnosed in symptomatic patients (less than 20% at 5 years), methods for its early diagnosis should be investigated. The use of cytology or Lugol chromoendoscopy in countries with a high incidence of epidermoid carcinoma or in individuals at increased risk (mainly alcoholics and smokers) has allowed early diagnosis and potentially curative treatment, substantially increasing life expectancy in this group of patients. These results should stimulate the evaluation and eventual implementation of programs to achieve early diagnosis and therefore greater survival in patients with epidermoid esophageal carcinoma in Western countries.
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Affiliation(s)
- D Nicolás Pérez
- Servicio de Aparato Digestivo, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España
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Wang KK, Wongkeesong M, Buttar NS. American Gastroenterological Association technical review on the role of the gastroenterologist in the management of esophageal carcinoma. Gastroenterology 2005; 128:1471-505. [PMID: 15887129 DOI: 10.1053/j.gastro.2005.03.077] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kenneth K Wang
- Barrett's Esophagus Unit, St. Mary's Hospital, Mayo Clinic, Rochester, Minnesota, USA
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Giovannini M, Ries P. [Diagnosis and endoscopic treatments of superficial carcinomas of the esophagus]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:540-5. [PMID: 15980747 DOI: 10.1016/s0399-8320(05)82125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Marc Giovannini
- Unité d'Endoscopie et des Tumeurs Digestives, Institut Paoli-Calmettes, Sainte-Marguerite, Marseille
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Lu XJ, Chen ZF, Guo CL, Li SS, Bai WL, Jin GL, Wang YX, Meng FS, Gao F, Hou J. Endoscopic survey of esophageal cancer in a high-risk area of China. World J Gastroenterol 2004. [PMID: 15378767 DOI: 10.1007/bf02739853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To characterize the histological types of esophageal and cardiac mucosa by endoscopic survey of a population in a high-risk area of esophageal cancer of China. METHODS A selected cohort of residents in Cixian County during December 2001 and May 2002 was surveyed by using Lugol's staining, followed by computer-based statistical analysis of the data with SPSS 10.0 software. RESULTS Histologically, the detection rates of squamous epithelial acanthosis, squamous epithelial atrophy, and basal cell hyperplasia in the esophagus were 1.9% (38/2,013), 0.1% (3/2,013) and 0.9% (18/2,013) respectively, and those of mild, moderate, and severe esophagitis were 34.9% (703/2,013), 1.6% (33/2,013) and 0.2% (2/2,013) respectively. Mild, moderate, and severe esophageal dysplasia were detected in 8.6% (172/2,013), 7.8% (157/2,013) and 2.6% (53/2,013) respectively in the selected population, whereas in situ carcinoma, intramucosal carcinoma, invasive squamous carcinoma of the esophagus in 2.5% (50/2,013), 0.2% (4/2,013) and 0.7% (14/2,013) respectively. The detection rates of non-atrophic gastritis and atrophic gastritis of the cardia were 36.3% (730/2,013) and 11.5% (232/2,013) respectively, with mild and severe dysplasia of the cardia detected in 2.5% (51/2,013) and 0.8% (17/2,013), respectively, in this population; the rates of intramucosal adenocarcinoma and invasive adenocarcinoma of the cardia were 0.1% (3/2,013) and 0.8% (17/2,013) respectively. The detection rate of esophageal cancer at early stage was 79.4% (54/68). The survey rate (ratio of examined population to expected population) was 73.8% (2,013/2,725). CONCLUSION Histologic types of the esophageal and cardiac mucosa were characterized by endoscopic survey in a high-risk population of esophageal cancer, which may help the early detection and treatment of esophageal and cardiac cancers and dysplasia, and reduce the mortality of such malignancies.
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Affiliation(s)
- Xu-Jing Lu
- Hebei Cancer Institute, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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Lu XJ, Chen ZF, Guo CL, Li SS, Bai WL, Jin GL, Wang YX, Meng FS, Gao F, Hou J. Endoscopic survey of esophageal cancer in a high-risk area of China. World J Gastroenterol 2004; 10:2931-5. [PMID: 15378767 PMCID: PMC4576246 DOI: 10.3748/wjg.v10.i20.2931] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIM: To characterize the histological types of esophageal and cardiac mucosa by endoscopic survey of a population in a high-risk area of esophageal cancer of China.
METHODS: A selected cohort of residents in Cixian County during December 2001 and May 2002 was surveyed by using Lugol’s staining, followed by computer-based statistical analysis of the data with SPSS 10.0 software.
RESULTS: Histologically, the detection rates of squamous epithelial acanthosis, squamous epithelial atrophy, and basal cell hyperplasia in the esophagus were 1.9% (38/2013), 0.1% (3/2013) and 0.9% (18/2013) respectively, and those of mild, moderate, and severe esophagitis were 34.9% (703/2013), 1.6% (33/2013) and 0.2% (2/2013) respectively. Mild, moderate, and severe esophageal dysplasia were detected in 8.6% (172/2013), 7.8% (157/2013) and 2.6% (53/2013) respectively in the selected population, whereas in situ carcinoma, intramucosal carcinoma, invasive squamous carcinoma of the esophagus in 2.5% (50/2013), 0.2% (4/2013) and 0.7% (14/2013) respectively. The detection rates of non-atrophic gastritis and atrophic gastritis of the cardia were 36.3% (730/2013) and 11.5% (232/2013) respectively, with mild and severe dysplasia of the cardia detected in 2.5% (51/2013) and 0.8% (17/2013), respectively, in this population; the rates of intramucosal adenocarcinoma and invasive adenocarcinoma of the cardia were 0.1% (3/2013) and 0.8% (17/2013) respectively. The detection rate of esophageal cancer at early stage was 79.4% (54/68). The survey rate (ratio of examined population to expected population) was 73.8% (2013/2725).
CONCLUSION: Histologic types of the esophageal and cardiac mucosa were characterized by endoscopic survey in a high-risk population of esophageal cancer, which may help the early detection and treatment of esophageal and cardiac cancers and dysplasia, and reduce the mortality of such malignancies.
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Affiliation(s)
- Xu-Jing Lu
- Hebei Cancer Institute, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
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Thuler FPBM, de Paulo GA, Ferrari AP. Chemical esophagitis after chromoendoscopy with Lugol's solution for esophageal cancer: case report. Gastrointest Endosc 2004; 59:925-6. [PMID: 15173818 DOI: 10.1016/s0016-5107(04)00173-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Muto M, Hironaka S, Nakane M, Boku N, Ohtsu A, Yoshida S. Association of multiple Lugol-voiding lesions with synchronous and metachronous esophageal squamous cell carcinoma in patients with head and neck cancer. Gastrointest Endosc 2002. [PMID: 12297767 DOI: 10.1016/s0016-5107(02)70436-7] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Affiliation(s)
- Manabu Muto
- Division of Endoscopy and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Zuluaga AF, Drezek R, Collier T, Lotan R, Follen M, Richards-Kortum R. Contrast agents for confocal microscopy: how simple chemicals affect confocal images of normal and cancer cells in suspension. JOURNAL OF BIOMEDICAL OPTICS 2002; 7:398-403. [PMID: 12175289 DOI: 10.1117/1.1481047] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2000] [Revised: 04/30/2001] [Accepted: 04/30/2001] [Indexed: 05/18/2023]
Abstract
Normal and malignant human cervical cancer cells were imaged in vivo with confocal, phase contrast, and brightfield microscopies. Results were compared between cells in growth medium before and after addition of acetic acid, hypertonic saline solution, toluidine blue, and Lugol's iodine. The exogenous agents changed the backscattering characteristics of the cells when measured with confocal microscopy at 808 nm. A tendency toward higher scattering was observed in treated cells. Acetic acid and toluidine blue increased the brightness of the nucleus with respect to the cytoplasm in normal and cancer cells. Hypertonic saline solution made the cytoplasm brighter than the nucleus in both types of cells. The results indicate that simple chemicals can be used to enhance confocal microscopy's ability to differentiate intracellular components, such as nuclear size and shape. This can further confocal microscopy's ability to assess disease in cells and tissues.
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Affiliation(s)
- Andrés F Zuluaga
- The University of Texas at Austin, Department of Electrical and Computer Engineering, Austin, Texas 78712, USA
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Scherübl H, von Lampe B, Faiss S, Däubler P, Bohlmann P, Plath T, Foss HD, Scherer H, Strunz A, Hoffmeister B, Stein H, Zeitz M, Riecken EO. Screening for oesophageal neoplasia in patients with head and neck cancer. Br J Cancer 2002; 86:239-43. [PMID: 11870513 PMCID: PMC2375180 DOI: 10.1038/sj.bjc.6600018] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2001] [Revised: 10/02/2001] [Accepted: 10/15/2001] [Indexed: 12/30/2022] Open
Abstract
Due to advanced disease at the time of diagnosis the prognosis of oesophageal cancer is generally poor. As mass screening for oesophageal cancer is neither feasible nor reasonable, high-risk groups should be identified and surveilled. The aim of this study was to define the risk of oesophageal cancer in patients with (previous) head and neck cancer. A total of 148 patients with (previous) head and neck cancer were prospectively screened for oesophageal cancer by video-oesophagoscopy and random oesophageal biopsies. Even in a macroscopically normal looking oesophagus, four biopsy specimens were taken every 3 cm throughout the entire length of the squamous oesophagus. Low- or high-grade squamous cell dysplasia was detected histologically in 10 of the 148 patients (6.8%). All but one dysplasias were diagnosed synchronously with the head and neck cancers. In addition, oesophageal squamous cell carcinoma was diagnosed in 11 of the 148 patients (7.4%). Most invasive cancers (63.6%) occurred metachronously. The risk of squamous cell neoplasia of the oesophagus is high in patients with (previous) head and neck cancer. Surveillance is recommended in this high-risk group.
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Affiliation(s)
- H Scherübl
- Medical Clinic I, University Hospital Benjamin Franklin, Free University of Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.
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Abstract
Squamous cell cancer is the most common neoplasm of the oesophagus worldwide, with an enormous variation in its global incidence. Several risk factors, such as achalasia, Plummer-Vinson syndrome, coeliac disease and nutritional factors, have been identified. The surveillance of patients, especially those with tylosis or caustic ingestion, has been recommended. Vital staining with iodine may improve the diagnosis of early cancer. The endoscopic management of early cancer and dysplasia by minimal invasive techniques such as photodynamic therapy or mucosal resection has become attractive for many of these patients with co-morbidity.
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Affiliation(s)
- H Messmann
- Department of Internal Medicine I, University of Regensburg, Germany
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46
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Schlemper RJ, Dawsey SM, Itabashi M, Iwashita A, Kato Y, Koike M, Lewin KJ, Riddell RH, Shimoda T, Sipponen P, Stolte M, Watanabe H. Differences in diagnostic criteria for esophageal squamous cell carcinoma between Japanese and Western pathologists. Cancer 2000; 88:996-1006. [PMID: 10699887 DOI: 10.1002/(sici)1097-0142(20000301)88:5<996::aid-cncr8>3.0.co;2-q] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Large discrepancies have been found between Western and Japanese pathologists in the diagnosis of adenoma/dysplasia versus carcinoma for gastric and colorectal glandular lesions. It is important to determine whether similar differences exist in the diagnosis of esophageal squamous lesions. METHODS Eleven expert gastrointestinal pathologists from Japan, North America, and Europe individually reviewed a set of microscopic slides containing 21 sections of biopsies and corresponding endoscopic mucosal resection specimens from Japanese patients with superficial esophageal squamous neoplastic lesions. The pathologists indicated the pathologic findings on which they based each diagnosis. RESULTS Invasion was the most important diagnostic criterion of carcinoma for the Western pathologists whereas nuclear and structural features were more important for the Japanese pathologists. For two sections showing low grade dysplasia according to most Western pathologists, the Japanese pathologists diagnosed suspected carcinoma in one case and definite carcinoma in the other. For nine sections with high grade dysplasia according to the Western pathologists, the Japanese pathologists diagnosed suspected carcinoma in two cases and definite carcinoma in seven cases. For six sections with suspected carcinoma according to most Western pathologists, the Japanese pathologists diagnosed suspected carcinoma in one case and definite carcinoma in five cases. Four sections showed definite carcinoma according to both the Western and Japanese pathologists. Thus, there was agreement among the Western and Japanese pathologists for only 5 of the 21 sections (kappa value, 0.04). However, when high grade dysplasia, noninvasive carcinoma, and suspected carcinoma were grouped together, the agreement was excellent (19 of the 21 sections; kappa value, 0.75). CONCLUSIONS In Japan, esophageal squamous cell carcinoma is diagnosed mainly based on nuclear criteria, even in cases judged to be noninvasive low grade dysplasia in the West. This difference in diagnostic practice may contribute to the relatively high incidence rate and good prognosis of superficial esophageal carcinoma in Japan. To improve the comparability of research data, the authors recommend that high grade dysplasia, noninvasive carcinoma, and suspected carcinoma be grouped together into one category of "noninvasive high grade neoplasia." [See editorial on pages 969-70, this issue.]
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Affiliation(s)
- R J Schlemper
- Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
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47
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Chen LQ, Hu CY, Ghadirian P, Duranceau A. Early detection of esophageal squamous cell carcinoma and its effects on therapy: an overview. Dis Esophagus 2000; 12:161-7. [PMID: 10631905 DOI: 10.1046/j.1442-2050.1999.00039.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Squamous cell carcinoma of the esophagus shows a wide variation in incidence worldwide. It is the fifth leading cause of cancer-related death in men and usually diagnosed at an advanced stage with unsatisfactory therapeutic results. The techniques available for early detection of esophageal carcinoma are reviewed in this paper, as well as its overall effect on survival. For the time being, only surgical resection at a very early stage may improve survival of the disease. Esophageal cancer can be treated at an earlier stage when it is diagnosed by mass screening detection. However, despite a high survival rate at 5 years, local recurrences and distal metastases may still occur even 10 years after treatment. Prevention and therapeutic intervention at an earlier stage before the oncologic process has resulted in cancer changes is necessary to alter the natural evolution of the disease.
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Affiliation(s)
- L Q Chen
- Department of Surgery, Université de Montréal, Center Hospitalier de L'Université de Montréal, Canada
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48
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Freitag CP, Barros SG, Kruel CD, Putten AC, Dietz J, Gruber AC, Diehl AS, Meurer L, Breyer HP, Wolff F, Vidal R, Arruda CA, Luz LP, Fagundes RB, Prolla JC. Esophageal dysplasias are detected by endoscopy with Lugol in patients at risk for squamous cell carcinoma in southern Brazil. Dis Esophagus 2000; 12:191-5. [PMID: 10631911 DOI: 10.1046/j.1442-2050.1999.00046.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diagnosis of squamous cell carcinoma of the esophagus is usually late. Staining of the mucosa with Lugol's solution during endoscopy has been suggested to identify early cancer/dysplasia and may improve prognosis. Lugol was tested during endoscopy in 96 asymptomatic subjects at risk for this tumor, who were found to have atypias after exfoliative cytology in southern Brazil. Biopsies were obtained in Lugol's 'stained' and 'unstained' areas in the esophageal mucosa and the histologic results were compared. 'Unstained' areas were present in 64 (66.7%) instances: 44 'unstained' areas over mucosa with normal appearance revealed seven dysplasias (four high and three low grade), whereas 20 'unstained' areas with visible lesions contained only one dysplasia (low grade). 'Stained' areas in 96 (100%) subjects showed two additional dysplasias (one high and one low grade). In this study, Lugol 'unstained' areas were of great value for detection of dysplasias (sensitivity = 80%; specificity = 63%; p = 0.01, Fisher's exact test; CI = 95%; odds ratio = 6.7).
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Affiliation(s)
- C P Freitag
- Gastroenterology and Pathology Services, Hospital de Clínicas de Porto Alegre, Brazil
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49
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Sorbi D, Gostout CJ. Polyp identification and marking: Chromoscopy, high-resolution and high-magnification endoscopy, tattooing, and clipping. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2000. [DOI: 10.1016/s1096-2883(00)80035-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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50
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Fukuzawa K, Noguchi Y, Yoshikawa T, Saito A, Doi C, Makino T, Takanashi Y, Ito T, Tsuburaya A. High incidence of synchronous cancer of the oral cavity and the upper gastrointestinal tract. Cancer Lett 1999; 144:145-51. [PMID: 10529014 DOI: 10.1016/s0304-3835(99)00223-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A high incidence of synchronous esophageal or gastric carcinoma in preoperative patients with carcinoma of the oral cavity was reported. Esophageal carcinoma was found in seven out of 56 patients (12.5%) and gastric cancer in five patients (8.9%) by videoendoscopy aided with lugol staining in the esophagus and indigocarmine solution in the stomach, although all patients were completely asymptomatic for these lesions. All patients were male, regular drinkers and heavy smokers. The depth of invasion of such tumors was limited to either mucosa or submucosa. Those esophageal and gastric lesions beside the primary oral cancers were positive for p53 protein by immunohistochemistry. Careful preoperative evaluation of not only the esophagus but also the stomach should be a routine procedure in patients with carcinoma of the oral cavity.
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Affiliation(s)
- K Fukuzawa
- First Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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