1
|
Lewis-Thompson I, Zhang EZ, Beard PC, Desjardins AE, Colchester RJ. All-optical ultrasound catheter for rapid B-mode oesophageal imaging. BIOMEDICAL OPTICS EXPRESS 2023; 14:4052-4064. [PMID: 37799692 PMCID: PMC10549740 DOI: 10.1364/boe.494878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/30/2023] [Accepted: 06/30/2023] [Indexed: 10/07/2023]
Abstract
All-optical ultrasound (OpUS) is an imaging paradigm that uses light to both generate and receive ultrasound, and has progressed from benchtop to in vivo studies in recent years, demonstrating promise for minimally invasive surgical applications. In this work, we present a rapid pullback imaging catheter for side-viewing B-mode ultrasound imaging within the upper gastrointestinal tract. The device comprised an ultrasound transmitter configured to generate ultrasound laterally from the catheter and a plano-concave microresonator for ultrasound reception. This imaging probe was capable of generating ultrasound pressures in excess of 1 MPa with corresponding -6 dB bandwidths > 20 MHz. This enabled imaging resolutions as low as 45 µm and 120 µm in the axial and lateral extent respectively, with a corresponding signal-to-noise ratio (SNR) of 42 dB. To demonstrate the potential of the device for clinical imaging, an ex vivo swine oesophagus was imaged using the working channel of a mock endoscope for device delivery. The full thickness of the oesophagus was resolved and several tissue layers were present in the resulting ultrasound images. This work demonstrates the promise for OpUS to provide rapid diagnostics and guidance alongside conventional endoscopy.
Collapse
Affiliation(s)
- India Lewis-Thompson
- Department of Medical Physics and
Biomedical Engineering,
University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences,
University College London, Charles Bell House, Foley Street, London, W1W 7TY, UK
| | - Edward Z. Zhang
- Department of Medical Physics and
Biomedical Engineering,
University College London, Gower Street, London, WC1E 6BT, UK
| | - Paul C. Beard
- Department of Medical Physics and
Biomedical Engineering,
University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences,
University College London, Charles Bell House, Foley Street, London, W1W 7TY, UK
| | - Adrien E. Desjardins
- Department of Medical Physics and
Biomedical Engineering,
University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences,
University College London, Charles Bell House, Foley Street, London, W1W 7TY, UK
| | - Richard J. Colchester
- Department of Medical Physics and
Biomedical Engineering,
University College London, Gower Street, London, WC1E 6BT, UK
- Wellcome/EPSRC Centre for Interventional
and Surgical Sciences,
University College London, Charles Bell House, Foley Street, London, W1W 7TY, UK
| |
Collapse
|
2
|
Fukami N. Endoscopic Submucosal Dissection in the Esophagus: Indications, Techniques, and Outcomes. Gastrointest Endosc Clin N Am 2023; 33:55-66. [PMID: 36375886 DOI: 10.1016/j.giec.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic submucosal dissection (ESD) is well-accepted endoscopic resection modality for esophageal lesions with benefits in certain situations. ESD offers potential cure for early esophageal cancer and detailed pathologic information for risk stratification. Techniques are mostly standardized, and the use of traction method is encouraged. Indication and proper techniques of ESD in esophageal disease and clinical outcomes will be discussed in this article with pearls for care planning and management during periprocedural period.
Collapse
Affiliation(s)
- Norio Fukami
- Mayo Clinic College of Medicine and Science, Mayo Clinic Arizona, 13400 E Shea Boulevard, Scottsdale, AZ 85259, USA.
| |
Collapse
|
3
|
Kobayashi N, Kobara H, Nishiyama N, Shi T, Chiyo T, Yachida T, Masaki T. Miniature-probe endoscopic ultrasonography using a rubber balloon to evaluate gastrointestinal carcinomas in poor underwater conditions. Endoscopy 2022; 54:E466-E467. [PMID: 34571561 DOI: 10.1055/a-1625-3639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Nobuya Kobayashi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
| | - Tingting Shi
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
| | - Taiga Chiyo
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
| | - Tatsuo Yachida
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kita, Kagawa, Japan
| |
Collapse
|
4
|
Yan Y, Ma Z, Ji X, Liu J, Ji K, Li S, Wu Q. A potential decision-making algorithm based on endoscopic ultrasound for staging early gastric cancer: a retrospective study. BMC Cancer 2022; 22:761. [PMID: 35831843 PMCID: PMC9281103 DOI: 10.1186/s12885-022-09870-0] [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: 03/17/2022] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical staging of gastric cancer (GC) before treatment is essential. Endoscopic ultrasound (EUS) is a recommended staging tool, but its efficacy remains controversial. Our previous prospective study evaluated the potential value of EUS for T staging and presented discrepancies. In this study, we aimed to evaluate the efficacy of EUS in T staging by comparing it with pathological staging. We analyze the factors that can potentially affect accuracy to identify suitable subgroups for EUS staging. METHODS Data from a total of 1763 consecutive patients with GC from January 2015 to December 2017 were analyzed. Results from EUS and pathological T staging were compared. The factors that might affect EUS's accuracy were analyzed. RESULTS The sensitivity, specificity, positive predictive value, and negative predictive value of EUS in patients with early GC were 62.08%, 96.13%, 90.94%, and 80.21%, respectively. The accuracy rates of uT1, uT2-uT4, and uT3-uT4 were 90.94%, 79.02%, and 78.39%, respectively. In multivariate analysis, underestimation was more likely to be observed in patients with tumors located in the middle or upper third of the stomach. Overestimation was more likely to be observed in patients with tumors located in the lower third or those without ulcer. Other factors affecting accuracy included ulcer, differentiation, larger size and undergoing surgery. CONCLUSION Our findings highlight the role of EUS in determining the T staging of GC. Overestimation and underestimation in T-staging were significantly associated with the tumor location in early GC, and a decision-making algorithm was proposed for clinical practice in early cancers based on these findings.
Collapse
Affiliation(s)
- Yan Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Zhonghua Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Xin Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiawei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ke Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Center of Gastrointestinal Cancer, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shijie Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China
| | - Qi Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Endoscopy, Peking University Cancer Hospital & Institute, #52 Fucheng Road Haidian District, Beijing, China.
| |
Collapse
|
5
|
Asai H, Furukawa K, Miyahara R, Funasaka K, Furune S, Nakamura M, Kawashima H, Ishigami M, Hirooka Y, Fujishiro M. Feasibility of endoscopic ultrasonography using a 60-MHz ultrasound miniature probe in the upper gastrointestinal tract. J Med Ultrason (2001) 2021; 49:61-69. [PMID: 34826014 DOI: 10.1007/s10396-021-01172-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The use of higher frequencies in ultrasound allows for a more detailed image. This study aimed to investigate the feasibility of delineating the gastrointestinal wall using a 60-MHz miniature ultrasound probe. METHODS A phantom study was performed using a multipurpose ultrasonic phantom model, and the depth of imaging was evaluated using 60-MHz and 20-MHz miniature probes and 7.5-MHz conventional convex-type endoscopic ultrasonography. A total of 25 visualized areas from a total of 16 specimens from 16 patients were enrolled. The structures of the layers of the esophagus, stomach, and duodenum were evaluated using a 60-MHz probe and a pathological specimen created from endoscopically or surgically resected specimens. RESULTS The 60-MHz probe was able to render to a depth of 2 mm and visualize the esophagus, stomach, and duodenum in five layers, respectively, within the depiction range. The depiction ranges of the 20-MHz probe and 7.5-MHz conventional endoscopic ultrasonography were 5 mm and 60 mm, respectively. The 60-MHz probe visualized the muscularis mucosae as the fourth layer in the esophagus, the fourth layer in the stomach, and the second layer in the duodenum. Muscularis mucosae were delineated in almost all cases, except in two cases where the layered structure disappeared. CONCLUSION The 60-MHz probe provided good visualization of the muscularis mucosae and structure of the layers down to the submucosa, which improves the ability to diagnose the depth of early cancer invasion of the upper gastrointestinal tract, leading to more appropriate treatments.
Collapse
Affiliation(s)
- Hiromitsu Asai
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Kohei Funasaka
- Department of Gastroenterology and Hepatology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Satoshi Furune
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yoshiki Hirooka
- Department of Gastroenterology and Hepatology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| |
Collapse
|
6
|
Wolfson P, Ho KMA, Bassett P, Haidry R, Olivo A, Lovat L, Sami SS. Accuracy of clinical staging for T2N0 oesophageal cancer: systematic review and meta-analysis. Dis Esophagus 2021; 34:6146603. [PMID: 33618359 DOI: 10.1093/dote/doab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/24/2020] [Accepted: 01/03/2021] [Indexed: 12/24/2022]
Abstract
Oesophageal cancer is the sixth commonest cause of overall cancer mortality. Clinical staging utilizes multiple imaging modalities to guide treatment and prognostication. T2N0 oesophageal cancer is a treatment threshold for neoadjuvant therapy. Data on accuracy of current clinical staging tests for this disease subgroup are conflicting. We performed a meta-analysis of all primary studies comparing clinical staging accuracy using multiple imaging modalities (index test) to histopathological staging following oesophagectomy (reference standard) in T2N0 oesophageal cancer. Patients that underwent neoadjuvant therapy were excluded. Electronic databases (MEDLINE, Embase, Cochrane Library) were searched up to September 2019. The primary outcome was diagnostic accuracy of combined T&N clinical staging. Publication date, first recruitment date, number of centers, sample size and geographical location main histological subtype were evaluated as potential sources of heterogeneity. The search strategy identified 1,199 studies. Twenty studies containing 5,213 patients met the inclusion criteria. Combined T&N staging accuracy was 19% (95% CI, 15-24); T staging accuracy was 29% (95% CI, 24-35); percentage of patients with T downstaging was 41% (95% CI, 33-50); percentage of patients with T upstaging was 28% (95% CI, 24-32) and percentage of patients with N upstaging was 34% (95% CI, 30-39). Significant sources of heterogeneity included the number of centers, sample size and study region. T2N0 oesophageal cancer staging remains inaccurate. A significant proportion of patients were downstaged (could have received endotherapy) or upstaged (should have received neoadjuvant chemotherapy). These findings were largely unchanged over the past two decades highlighting an urgent need for more accurate staging tests for this subgroup of patients.
Collapse
Affiliation(s)
- Paul Wolfson
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - Kai Man Alexander Ho
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | | | - Rehan Haidry
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - Alessandro Olivo
- Department of Medical Physics and Bioengineering, University College London, London, UK
| | - Laurence Lovat
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| | - Sarmed S Sami
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Gastroenterology, University College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
7
|
Kashani Ilkhechi A, Ceroici C, Dew E, Zemp R. Transparent capacitive micromachined ultrasound transducer linear arrays for combined realtime optical and ultrasonic imaging. OPTICS LETTERS 2021; 46:1542-1545. [PMID: 33793481 DOI: 10.1364/ol.415975] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
Transparent ultrasound transducers could enable many novel applications involving both ultrasonics and optics. Recently, we reported transparent capacitive micromachined ultrasound transducers (CMUTs) and demonstrated through-illumination photoacoustic imaging. This work presents the feasibility of transparent CMUTs for combined ultrasound imaging and through-array white-light imaging with a miniature camera placed behind the array. Transparent CMUT devices are fabricated with an adhesive wafer bonding technique and provide high transparency up to 90% in visible wavelengths. Fabricated linear arrays have a central operating frequency of 9 MHz with 128 active elements. Realtime plane-wave imaging is performed for ultrasound imaging, and lateral and axial resolutions of, respectively, 234 and 338 µm are achieved. Transparent CMUT has demonstrated a high transmit sensitivity of 1.4 kPa/V per channel with a 100 VDC bias voltage. The signal-to-noise ratio for a beamformed image of wire targets is determined to be 28.4 dB. To the best of our knowledge, this is the first report of combined realtime optical and ultrasonic imaging with transparent arrays. This technology may enable one to visually see what is being scanned and scan what one sees without co-registration errors. Future applications could include multi-modality probes for interventional and surgical procedures.
Collapse
|
8
|
Seifert H, Fusaroli P, Arcidiacono PG, Braden B, Herth F, Hocke M, Larghi A, Napoleon B, Rimbas M, Ungureanu BS, Sãftoiu A, Sahai AV, Dietrich CF. Controversies in EUS: Do we need miniprobes? Endosc Ultrasound 2021; 10:246-269. [PMID: 34380805 PMCID: PMC8411553 DOI: 10.4103/eus-d-20-00252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This is the fifth in a series of papers entitled "Controversies in EUS." In the current paper, we deal with high-resolution catheter probes, otherwise known as EUS miniprobes (EUS-MPs). The application of miniprobes for early carcinomas in the entire intestinal tract, for subepithelial lesions, and for findings in the bile duct and pancreatic duct as well as endobronchial use is critically discussed. Submucous lesions, especially in the colon, but also early carcinomas in special cases are considered the most important indications. The argument is illustrated by numerous examples.
Collapse
Affiliation(s)
- Hans Seifert
- Department of Gastroenterology, Evangelisches Krankenhaus, Oldenburg; Universitatsklinik fur Innere Medizin - Gastroneterologie, Hepatologie; Klinikum Oldenburg, Germany
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Paolo Giorgio Arcidiacono
- Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I, John Radcliffe Hospital I, Oxford, OX3 9DU, UK
| | - Felix Herth
- 2nd Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center (TLRCH), Member of the German Lung Research Foundation (DZL), University of Heidelberg, Heidelberg, Germany
| | - Michael Hocke
- Department of Medicine, Helios Klinikum Meiningen, Meiningen, Germany
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Bertrand Napoleon
- 2nd Digestive Endoscopy Unit, HopitalPrivé J Mermoz Ramsay Générale de Santé, Lyon, France
| | - Mihai Rimbas
- Department of Gastroenterology, Colentina Clinical Hospital, Bucharest; Department of Internal Medicine, Carol Davila University of Medicine Bucharest, Romania
| | - Bogdan Silvio Ungureanu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Adrian Sãftoiu
- Research Center of Gastroenterology and Hepatology Craiova, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Christoph F Dietrich
- Department of Allgemeine Innere Medizin, Kliniken Hirslanden, Beau Site, Salem und Permanence, Bern, Switzerland; Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| |
Collapse
|
9
|
Takamaru H, Yoshinaga S, Takisawa H, Oda I, Katai H, Sekine S, Taniguchi K, Saito Y. Endoscopic Ultrasonography Miniature Probe Performance for Depth Diagnosis of Early Gastric Cancer with Suspected Submucosal Invasion. Gut Liver 2020; 14:581-588. [PMID: 31816675 PMCID: PMC7492497 DOI: 10.5009/gnl19243] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/10/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background/Aims The accurate assessment of the depth of invasion of early gastric cancer (EGC) is critical to determine the most appropriate treatment option. However, it is difficult to distinguish shallow submucosal (SM1) invasion from deeper submucosal (SM2) invasion. We investigated the diagnostic performance of endoscopic ultrasonography (EUS) using a miniature probe for EGC with suspected SM invasion. Methods From April 2008 to June 2018, EGCs with suspected SM invasion were analyzed retrospectively. The EGCs examined by a 20 MHz high-frequency miniature probe was included in our study. Esophago-gastric junction cancers and patients treated by chemotherapy before resection were excluded. The sensitivity and specificity for the detection of SM2 invasion by EUS were compared with those of white light imaging (WLI). Additionally, factors related to depth underestimation or overestimation were investigated using multivariate analysis. Results A total of 278 EGCs in 259 patients were included in the final analysis. The sensitivity and specificity for SM2 or deeper by EUS were 73.7% (87/118) and 74.4% (119/160), respectively. The sensitivity and specificity by WLI were 47.5% (56/118) and 68.1% (109/160), respectively. The sensitivity of EUS was significantly superior to that of conventional endoscopy (p<0.01). Multivariate analysis revealed that an anterior location of the EGC was an independent risk factor for underestimation by EUS (odds ratio, 3.3; 95% confidence interval, 1.1 to 9.8; p=0.03). Conclusions The depth diagnostic performance for EGCs with suspected SM invasion using EUS was satisfactory and superior to that of conventional endoscopy. Additionally, it is important to recognize factors that may lead to misdiagnosis in those lesions.
Collapse
Affiliation(s)
- Hiroyuki Takamaru
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | | | - Hajime Takisawa
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| | - Hitoshi Katai
- Divisions of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shigeki Sekine
- Divisions of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Yutaka Saito
- Divisions of Endoscopy, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
10
|
Graham MT, Huang J, Creighton FX, Lediju Bell MA. Simulations and human cadaver head studies to identify optimal acoustic receiver locations for minimally invasive photoacoustic-guided neurosurgery. PHOTOACOUSTICS 2020; 19:100183. [PMID: 32695578 PMCID: PMC7364163 DOI: 10.1016/j.pacs.2020.100183] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 05/18/2023]
Abstract
Real-time intraoperative guidance during minimally invasive neurosurgical procedures (e.g., endonasal transsphenoidal surgery) is often limited to endoscopy and CT-guided image navigation, which can be suboptimal at locating underlying blood vessels and nerves. Accidental damage to these critical structures can have severe surgical complications, including patient blindness and death. Photoacoustic image guidance was previously proposed as a method to prevent accidental injury. While the proposed technique remains promising, the original light delivery and sound reception components of this technology require alterations to make the technique suitable for patient use. This paper presents simulation and experimental studies performed with both an intact human skull (which was cleaned from tissue attachments) and a complete human cadaver head (with contents and surrounding tissue intact) in order to investigate optimal locations for ultrasound probe placement during photoacoustic imaging and to test the feasibility of a modified light delivery design. Volumetric x-ray CT images of the human skull were used to create k-Wave simulations of acoustic wave propagation within this cranial environment. Photoacoustic imaging of the internal carotid artery (ICA) was performed with this same skull. Optical fibers emitting 750 nm light were inserted into the nasal cavity for ICA illumination. The ultrasound probe was placed on three optimal regions identified by simulations: (1) nasal cavity, (2) ocular region, and (3) 1 mm-thick temporal bone (which received 9.2%, 4.7%, and 3.8% of the initial photoacoustic pressure, respectively, in simulations). For these three probe locations, the contrast of the ICA in comparative experimental photoacoustic images was 27 dB, 19 dB, and 12 dB, respectively, with delay-and-sum (DAS) beamforming and laser pulse energies of 3 mJ, 5 mJ, and 4.2 mJ, respectively. Short-lag spatial coherence (SLSC) beamforming improved the contrast of these DAS images by up to 15 dB, enabled visualization of multiple cross-sectional ICA views in a single image, and enabled the use of lower laser energies. Combined simulation and experimental results with the emptied skull and >1 mm-thick temporal bone indicated that the ocular and nasal regions were more optimal probe locations than the temporal ultrasound probe location. Results from both the same skull filled with ovine brains and eyes and the human cadaver head validate the ocular region as an optimal acoustic window for our current system setup, producing high-contrast (i.e., up to 35 dB) DAS and SLSC photoacoustic images within the laser safety limits of a novel, compact light delivery system design that is independent of surgical tools (i.e., a fiber bundle with 6.8 mm outer diameter, 2 mm-diameter optical aperture, and an air gap spacing between the sphenoid bone and fiber tips). These results are promising toward identifying, quantifying, and overcoming major system design barriers to proceed with future patient testing.
Collapse
Affiliation(s)
- Michelle T. Graham
- Department of Electrical and Computer Engineering, Johns Hopkins University
- Corresponding author.
| | - Jiaqi Huang
- Department of Biomedical Engineering, Johns Hopkins University
| | | | - Muyinatu A. Lediju Bell
- Department of Electrical and Computer Engineering, Johns Hopkins University
- Department of Biomedical Engineering, Johns Hopkins University
- Department of Computer Science, Johns Hopkins University
| |
Collapse
|
11
|
Endoscopic resection of early squamous neoplasia of the oesophagus: long-term follow-up in a UK population from a tertiary hospital. Eur J Gastroenterol Hepatol 2020; 32:789-796. [PMID: 32302087 DOI: 10.1097/meg.0000000000001692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To review the efficacy and outcomes of endoscopic resection in the diagnosis and treatment of oesophageal squamous dysplasia and early neoplasia. METHODS This was a retrospective study between May 2012-2018. Twenty-one patients were treated with or considered for treatment with endoscopic resection at a tertiary hospital in the UK. The primary outcome was curative resection, defined as histologically proven complete resection of the lesion with deep/vertical margin ≥1 mm from neoplasia. Secondary outcomes were changes in staging from endoscopic resection histology, whether there was a complete reversal of dysplasia at 12-months or the latest endoscopic follow-up and 5-year overall survival rate. RESULTS Seventeen patients (mean age = 66.5 years) with 20 lesions (35% en-bloc; 65% piecemeal resections) had endoscopic resection performed. Complete resection was achieved in 90% of lesions by endoscopic criteria, but this was confirmed in fewer lesions histologically. Curative resection was achieved histologically in 60% of lesions (11 patients) and noncurative resection in 40% of lesions (6 patients). Changes in staging from endoscopic resection histology were found in 79.2% of lesions (41.7% upstaged; 37.5% downstaged). No patients were found to have recurrence at their 12-month endoscopic follow-up. Eight of the 11 patients (72.7%) with curative resection remained clear of dysplasia/neoplasia throughout their follow-up (mean, 24.3 months; median, 19 months). The five-year overall survival rate was 64%. CONCLUSION In UK, endoscopic resection is useful in the management of early squamous neoplasia both for staging and (by piecemeal endoscopic resection in elderly unfit) for medium- to long-term disease clearance.
Collapse
|
12
|
Song BI. Nomogram using F-18 fluorodeoxyglucose positron emission tomography/computed tomography for preoperative prediction of lymph node metastasis in gastric cancer. World J Gastrointest Oncol 2020; 12:447-456. [PMID: 32368322 PMCID: PMC7191335 DOI: 10.4251/wjgo.v12.i4.447] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/13/2020] [Accepted: 03/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lymph node (LN) metastasis is an important prognostic factor in patients with gastric cancer (GC). However, the evaluation of LN metastasis status in the preoperative setting is not accurate. Therefore, precise preoperative prediction of LN metastasis status is crucial for optimal treatment in patients with GC.
AIM To develop a preoperative nomogram for LN metastasis using F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) and preoperative laboratory test findings in GC.
METHODS In this study, the data of 566 GC patients who underwent preoperative F-18 FDG PET/CT and subsequent surgical resection were analyzed. The LN metastasis prediction model was developed in the training cohort and validated in the internal validation cohort. Routine preoperative laboratory tests, including albumin and carbohydrate antigen (CA) 19-9 were performed in all patients. Univariate and multivariable logistic regression was performed to validate the preoperative predictive indicators for LN metastasis.
RESULTS Of the 566 patients, 232 (41%) had confirmed histopathologic LN metastasis. Univariate logistic regression revealed that the tumor location, blood hemoglobin, serum albumin levels, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, CA 19-9, maximum standardized uptake value (SUVmax) of the primary tumor (T_SUVmax), and SUVmax of LN (N_SUVmax) were significantly associated with LN metastasis. In multivariate analysis, T_SUVmax (OR = 1.08; 95%CI: 1.02–1.15; P = 0.011) and N_SUVmax (OR = 1.49; 95%CI: 1.19–1.97; P = 0.002) were found to be significant predictive factors for LN metastasis. The LN metastasis prediction model using T_SUVmax, N_SUVmax, serum albumin, and CA 19-9 yielded an area under the curve (AUC) of 0.733 (95%CI: 0.683–0.784, P = 0.025) in the training cohort and AUC of 0.756 (95%CI: 0.678–0.833, P < 0.001) in the test cohort.
CONCLUSION T_SUVmax and N_SUVmax measured by preoperative F-18 FDG PET/CT are independent predictive factors for LN metastasis in GC.
Collapse
Affiliation(s)
- Bong-Il Song
- Department of Nuclear Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
| |
Collapse
|
13
|
Yoshida T, Hashimoto S, Mizuno KI, Ichikawa H, Yokoyama J, Umezu H, Terai S. Advanced squamous cell carcinoma in an asymptomatic, large, epiphrenic esophageal diverticulum. Clin J Gastroenterol 2020; 13:477-482. [PMID: 31989447 DOI: 10.1007/s12328-020-01098-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
Abstract
An asymptomatic epiphrenic diverticulum (ED) was diagnosed in a man undergoing annual esophagogastroduodenoscopy (EGD) at another hospital 40 years before he presented to our hospital at age 63 years for his annual EGD. However, because substantial food retention was found in the ED, we could not confirm a lesion. After the retained food was removed endoscopically, a second EGD showed a reddish, flat lesion with an elevated mass within the ED. Endoscopic ultrasonography indicated that the elevated mass was deep in the submucosal layer. An esophagram showed that the ED was approximately 80 mm in diameter, which is considered large. An endoscopic biopsy of the lesion confirmed squamous cell carcinoma. Total esophagectomy was performed. Microscopic examination revealed well-differentiated to moderately differentiated squamous cell carcinoma invading the adventitia at the elevated lesion. The final pathological stage was pT3N0M0. There was no evidence of recurrence for 3 years during the quarterly follow-up examinations. To our knowledge, this case involved the longest asymptomatic term (40 years) since the ED was detected. A review of 18 reported cases of carcinoma in an ED indicated that advanced cancer has a poor prognosis. Periodic follow-up of ED patients is essential for early diagnosis.
Collapse
Affiliation(s)
- Tomoaki Yoshida
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata , Niigata, 951-8510, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata , Niigata, 951-8510, Japan.
| | - Ken-Ichi Mizuno
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata , Niigata, 951-8510, Japan
| | - Hiroshi Ichikawa
- Division of Digestive and General Surgery, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Junji Yokoyama
- Department of Endoscopy, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Hajime Umezu
- Division of Pathology, Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, Niigata, 951-8510, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata , Niigata, 951-8510, Japan
| |
Collapse
|
14
|
Kim Y, Kuan JY, Ratcliffe E, Baskind S, Prasad N, Assadsangabi A, Ang Y. Long-term follow-up of endoscopic submucosal dissection of gastric dysplasia and early neoplasia in a United Kingdom Caucasian population - a tertiary centre experience. Scand J Gastroenterol 2020; 55:18-26. [PMID: 31906741 DOI: 10.1080/00365521.2019.1707865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Endoscopic submucosal dissection (ESD) is extensively performed for the treatment of early gastric cancer (EGC) in the Eastern countries due to its favourable outcomes compared to gastrectomy in terms of lower complication rates, shorter hospital stays, better quality of life, with similar 5-year survival rate. Yet, its use is still limited in the UK.Aim: A long-term follow-up study to evaluate the outcome of ESD in the treatment of EGC in a Caucasian population at a tertiary referral centre in the United Kingdom.Methods: Data for the 35 Caucasian patients, who underwent ESD in a tertiary referral centre between May 2012 and June 2017 were collected. The selected patients were followed-up until May 2018. Curative resection (CR) and survival rates were used to measure the efficacy of ESD.Results: ESD was attempted on 46 lesions and completed on 37. En-bloc and CR rates of 57% and 19% were achieved, respectively. 24% of the lesions were non-CR and 57% were indefinite for non-CR/CR and 41% of the lesions showed change in histological grade post-ESD. Complete reversal of dysplasia/neoplasia was seen in 60% of the 'indefinite' group and 100% of the CR group at latest FU (18 months, mean). Recurrence was seen in 23% of the patients at latest FU. Seventy-one months' survival rate was 77%, while the disease-specific mortality was 0%.Conclusions: This study demonstrates the positive long-term outcome of ESD for gastric neoplasia in a UK Caucasian population, encouraging further development and implementation of ESD in the UK.
Collapse
Affiliation(s)
- Yeson Kim
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester UK
| | - Jen Yee Kuan
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester UK
| | - Elizabeth Ratcliffe
- Gastroenterology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Samuel Baskind
- Gastroenterology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Neeraj Prasad
- Gastroenterology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK.,Gastroenterology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Arash Assadsangabi
- Gastroenterology Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Yeng Ang
- Gastroenterology Department, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, School of Medical Sciences, Division of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| |
Collapse
|
15
|
Yan Y, Wu Q, Li ZY, Bu ZD, Ji JF. Endoscopic ultrasonography for pretreatment T-staging of gastric cancer: An in vitro accuracy and discrepancy analysis. Oncol Lett 2019; 17:2849-2855. [PMID: 30854060 PMCID: PMC6365933 DOI: 10.3892/ol.2019.9920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/23/2018] [Indexed: 12/19/2022] Open
Abstract
In the current era of multi-disciplinary treatment, precise and detailed diagnosis prior to treatment is crucial for clinical practice. For different lesions that fit different indications, the optimum approach for treatment differs significantly. Thus, the recent 8th American Joint Committee on Cancer classification system has introduced 'clinical stage' as a criterion. Endoscopic ultrasonography (EUS) has been the first-line choice for pretreatment staging; however, there is no standardization of the depth classification nor a standard EUS method. Additionally, the accuracy for this diagnostic test has ranged between <40 and 90% in previous studies. The aim of the present study was to determine the accuracy of EUS, identify the discrepancies between EUS and histological results, and analyze the underlying causes. Between June 2014 and February 2016, EUS was performed on gastric carcinoma specimens from 60 consecutive patients. EUS was performed on the resected specimens following surgery, but prior to fixation in formalin, invasion of the gastric wall was determined and the deepest location was marked with sutures. The ultrasound images were independently interpreted, and the quality of the images was scored by two endoscopists. Subsequently, the ultrasound images were compared with the pathological results of the same section. The overall accuracy of EUS was 75%. For locally advanced gastric cancers, EUS had a relatively high accuracy (33/43, 86%). The EUS results corresponded well with the pathological hematoxylin and eosin staining results, and the deepest points determined by EUS were confirmed by pathology in the majority of cases (85%). In total, 50 and 10 cases were scored as having high/moderate and low quality, associated with accuracies of 86% (43/50) and 20% (2/10), respectively. EUS is valuable for pretreatment T-staging, particularly for advanced cases. Proximal stomach cancer exhibited a tendency for improved accuracy. Overall, the results of the present study suggest that standardized scanning processes, particularly including all-encompassing scanning, proper probe-placement and high image quality, lead to improved accuracy of EUS.
Collapse
Affiliation(s)
- Yan Yan
- Endoscopy Center, Beijing Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Qi Wu
- Endoscopy Center, Beijing Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Zi-Yu Li
- Department of Gastrointestinal Surgery, Beijing Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Zhao-De Bu
- Department of Gastrointestinal Surgery, Beijing Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| | - Jia-Fu Ji
- Department of Gastrointestinal Surgery, Beijing Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, P.R. China
| |
Collapse
|
16
|
Sooltangos A, Davenport M, McGrath S, Vickers J, Senapati S, Akhtar K, George R, Ang Y. Gastric endoscopic submucosal dissection as a treatment for early neoplasia and for accurate staging of early cancers in a United Kingdom Caucasian population. World J Gastrointest Endosc 2017; 9:561-570. [PMID: 29290911 PMCID: PMC5740101 DOI: 10.4253/wjge.v9.i12.561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/18/2017] [Accepted: 11/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the efficacy of endoscopic submucosal dissection (ESD) at diagnosing and treating superficial neoplastic lesions of the stomach in a United Kingdom Caucasian population.
METHODS Data of patients treated with or considered for ESD at a tertiary referral center in the United Kingdom were retrieved for a period of 2 years (May 2015 to June 2017) from the electronic patient records of the hospital. Only Caucasian patients were included. Primary outcomes were curative resection (CR) and were defined as ESD resections with clear horizontal and vertical margin and an absence of lympho-vascular invasion, poor differentiation and submucosal involvement on histological evaluation of the resected specimen. Secondary end-points were reversal of dysplasia at 12 mo endoscopic follow-up and/or at the latest follow up. Change in histological diagnosis pre and post ESD was also analysed.
RESULTS Twenty-four patients were initially identified with intention to treat. 19 patients were eligible after mapping gastroscopy and ESD was attempted on a total of 25 ESD lesions, 4 of which failed and had to be aborted mid-procedure. Out of 21 ESD performed, en-bloc resection was achieved in 71.4% of cases. Resection was considered complete on endoscopy in 90.5% of cases compared to only 38.1% on histology. A total of 6 resections were considered curative (28%), 5 non-curative (24%) and 10 indefinite for CR or non-CR (24%). ESD changed the histological diagnosis in 66.6% of cases post ESD. Endoscopic follow-up in the “indefinite” group and CR group showed that 50% and 80% of patients were clear of dysplasia at the latest follow-up respectively; 2 cases of recurrence were observed in the “indefinite”group. Survival rate for the entire cohort was 91.7%.
CONCLUSION This study provides early evidence for the efficacy of ESD as a therapeutic and diagnostic intervention in Caucasian populations and supports its application in the United Kingdom.
Collapse
Affiliation(s)
- Aisha Sooltangos
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
| | - Matthew Davenport
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
| | - Stephen McGrath
- Department of Pathology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
| | - Jonathan Vickers
- Department of Upper Gastrointestinal Surgery, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
| | - Siba Senapati
- Department of Upper Gastrointestinal Surgery, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
| | - Kurshid Akhtar
- Department of Upper Gastrointestinal Surgery, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
| | - Regi George
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
- Department of Gastroenterology, Pennine Acute NHS Trust, Rochdale Old Rd, Bury BL9 7TD, United Kingdom
| | - Yeng Ang
- Department of Gastroenterology, Salford Royal NHS Foundation Trust, Salford M6 8HD, United Kingdom
- Gastrointestinal Science, University of Manchester, Manchester M13 9PL, United Kingdom
| |
Collapse
|
17
|
Fu K, Jin P, He Y, Suzuki M, Sheng J. A superficial esophageal cancer in an epiphrenic diverticulum treated by endoscopic submucosal dissection. BMC Gastroenterol 2017; 17:94. [PMID: 28784105 PMCID: PMC5547519 DOI: 10.1186/s12876-017-0649-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/31/2017] [Indexed: 12/19/2022] Open
Abstract
Background We report a unique case of a superficial esophageal cancer arising in a single diverticulum, diagnosed with magnifying image-enhanced endoscopy and then successfully treated by endoscopic submucosal dissection (ESD). Case presentation A 66-year-old man with alcohol-related liver injury visited our hospital for endoscopy for investigation of varix. Esophagogastroduodenoscopy showed no varix but a large epiphrenic diverticulum with an area of fainted redness just above the esophagogastric junction. Narrow band imaging revealed a sharply demarcated brownish dotted area, and dilated intra-epithelial papillary capillary loops (IPCL) were subsequently seen after magnification. Chromoendoscopy with 1% Lugol’s iodine solution demonstrated a well-demarcated unstained area, approximately 20 mm in diameter. Endoscopic biopsy revealed a squamous cell carcinoma (SCC). Conclusion The tumor was completely resected by ESD without perforation. Histologically, it was an intraepithelial SCC without lympho-vascular invasion of cancer cells. No local recurrence or metastasis was detected at the last follow-up of 42 months.
Collapse
Affiliation(s)
- Kuangi Fu
- Department of Gastroenterology, Kanma Memorial Hospital, 2-5, Nasushiobara city, Tochigi, 325-0046, Japan. .,Department of Gastroenterology, PLA Army General Hospital, Beijing, 100700, China.
| | - Peng Jin
- Department of Gastroenterology, PLA Army General Hospital, Beijing, 100700, China
| | - Yuqi He
- Department of Gastroenterology, PLA Army General Hospital, Beijing, 100700, China
| | - Masanori Suzuki
- Department of Gastroenterology, Kanma Memorial Hospital, 2-5, Nasushiobara city, Tochigi, 325-0046, Japan
| | - Jianqiu Sheng
- Department of Gastroenterology, PLA Army General Hospital, Beijing, 100700, China
| |
Collapse
|
18
|
Comparison of endoscopic ultrasonography and magnifying endoscopy for assessment of the invasion depth of shallow gastrointestinal neoplasms: a systematic review and meta-analysis. Surg Endosc 2017; 31:4923-4933. [PMID: 28547665 DOI: 10.1007/s00464-017-5596-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/11/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To conduct a meta-analysis to provide accurate evidence regarding the preferred diagnostic method, magnifying endoscopy (ME) or endoscopic ultrasonography (EUS), for assessment of the depth of invasion of the gastrointestinal neoplasms. METHODS PubMed, EMBASE, Ovid Medline, and the Cochrane Library databases were searched for studies published between January 1946 and October 2016, regarding the use of EUS and ME to assess the invasion depth of gastrointestinal cancers. The quality of diagnostic studies was evaluated using the QUADAS2 instrument. The Meta-DiSc software (version 1.4) was used for meta-analysis of the pooled data regarding the diagnostic accuracy of EUS and ME of the invasion depth of gastrointestinal neoplasms. RESULTS Our meta-analysis included the data of 754 patients with gastrointestinal cancers contributed by seven prospective studies. All studies were of high quality (QUADAS2). The receiver operating characteristic (ROC) planes were not observed in shoulder and arm forms for either EUS or ME, with Spearman's correlation coefficients of -0.821 and 0.234 for EUS and ME, respectively. The p values of the diagnostic odds ratio for EUS and ME were 0.0038 and 0.0131, respectively. The sensitivity and specificity of EUS for the diagnosis of the depth of invasion of gastrointestinal cancers were 0.75 (95% CI 0.69-0.81) and 0.84 (95% CI 0.79-0.88), respectively. In comparison, the sensitivity and specificity for ME were 0.74 (95% CI 0.67-0.69) and 0.85 (95% CI 0.80-0.89), respectively. The values of area under the summary ROC (SROC) curves for EUS and ME were 0.8499 and 0.8757, respectively, with a non-significant Z value between EUS and MR (0.296 < 1.96). CONCLUSIONS Both EUS and ME provide a comparable performance for judging the depth of invasion of gastrointestinal neoplasms. However, there is heterogeneity between studies contributed by non-threshold effects.
Collapse
|
19
|
Ning B, Abdelfatah MM, Othman MO. Endoscopic submucosal dissection and endoscopic mucosal resection for early stage esophageal cancer. Ann Cardiothorac Surg 2017; 6:88-98. [PMID: 28446997 DOI: 10.21037/acs.2017.03.15] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Mortality from esophageal cancer remains high despite advances in medical therapy. Although the incidence of squamous cell carcinoma of the esophagus remains unchanged, the incidence of the esophageal adenocarcinoma has increased over time. Gastroesophageal reflux disease (GERD and obesity are contributing factors to the development of Barrett's esophagus and subsequent development of adenocarcinoma. Early recognition of the disease can lead to resection of esophageal cancer prior to the development of lymphovascular invasion. Various modalities have been implemented to aid identification of precancerous lesions and early esophageal cancer. Chromoendoscopy, narrowband imaging and endoscopic ultrasound examination are typically used for evaluating early esophageal lesions. Recently, confocal laser endomicroscopy (CLE) and volumetric laser scanning were implemented with promising results. Endoscopic management of early esophageal cancer may be done using endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Both techniques allow resection of the mucosa (and possibly a portion of the submucosa) containing the early tumor without interruption of deeper layers. A submucosal injection creating a cushion coupled with snare resection or cap assisted mucosal suction followed by ligation and snare resection are the most common techniques of EMR. EMR can remove lesions less than 2 cm in size en bloc. Larger lesions may require resection in piecemeal fashion. This may limit assessment of the margins of the lesion and orienting the lesion's border. ESD offers en bloc dissection of the lesion regardless of its size. ESD is performed with specialized needle knives, which allow incision followed by careful dissection of the lesion within the submucosal layer. Tumor recurrence after ESD is rare but the technique is labor intensive and has an increased risk of perforation. Esophageal stenosis remains a concern after extensive EMR or ESD. Dilation with balloon or stent placement is usually sufficient to treat post-resection stenosis.
Collapse
Affiliation(s)
- Bo Ning
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China
| | - Mohamed M Abdelfatah
- Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX, USA
| | - Mohamed O Othman
- Division of Gastroenterology, Department of Internal Medicine, East Carolina University, Greenville, NC, USA
| |
Collapse
|
20
|
Fujimoto A, Goto O, Nishizawa T, Ochiai Y, Horii J, Maehata T, Akimoto T, Kinoshita S, Sagara S, Sasaki M, Uraoka T, Yahagi N. Gastric ESD may be useful as accurate staging and decision of future therapeutic strategy. Endosc Int Open 2017; 5:E90-E95. [PMID: 28210705 PMCID: PMC5303017 DOI: 10.1055/s-0042-119392] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and study aims We sometimes perform gastric endoscopic submucosal dissection (ESD) for total pathologic diagnosis when preoperative diagnosis is difficult. In the present study we analyzed the treatment outcomes and adverse events of diagnostic ESD for early gastric cancer (EGC). Patients and methods We conducted a retrospective analysis of 18 consecutive cases of EGC in 18 patients with a suspected out-of-indication diagnosis who underwent diagnostic ESD, between June 2010 and November 2014. The following parameters were examined: the average length of the longer axis of the lesion; the procedure time; the rates of en bloc resection (ER), complete en bloc resection (CER), and curative resection (CR) as treatment outcomes; and the rates of perforation, delayed bleeding, aspiration pneumonia, disease-related death, and emergency surgery as adverse events. Results The treatment outcomes were as follows: average length of the longer axis of the lesion, 27.4 ± 10.0 mm; procedure time, 87.0 ± 43.1 minutes; ER rate, 18/18 (100.0 %); CER rate, 13/18 (72.2 %); CR rate, 4/18 (22.2 %). CR rate was achieved 37.5 % for the lesions which preoperative diagnosis was more than 30 mm (> 30 mm) in diameter differentiated type with mucosal layer/submucosal layer 1 invasion and ulceration positive. The adverse events (AEs) were perforation in 1 of 18 (5.5 %) patients and delayed bleeding in 1 of 18 (5.5 %). There were no other AEs. Conclusions Diagnostic ESD may be acceptable for future therapeutic strategy when we unconfirmed the pre ESD diagnosis because of lower rate of adverse events and high rate of ER.
Collapse
Affiliation(s)
- Ai Fujimoto
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan,Corresponding author Ai Fujimoto MD, PhD 35 ShinanomachiShinjyuku-kuTokyo, Japan 160-8582+81-3-5363-3895+81-3-5363-3895
| | - Osamu Goto
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Toshihiro Nishizawa
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Yasutoshi Ochiai
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Joichiro Horii
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Tadateru Maehata
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Teppei Akimoto
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Satoshi Kinoshita
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Seiji Sagara
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Motoki Sasaki
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Toshio Uraoka
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| | - Naohisa Yahagi
- Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University, Tokyo, Japan
| |
Collapse
|
21
|
de Magalhães Gomes R, Soletti RC, Soldan M, Madi K, Foster FS, Machado JC. In Vivo Endoluminal Ultrasound Biomicroscopy and Endoscopy of Inflamed Rat Esophagus. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:2687-2696. [PMID: 27530211 DOI: 10.1016/j.ultrasmedbio.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/28/2016] [Accepted: 07/02/2016] [Indexed: 06/06/2023]
Abstract
The development of high-frequency endoscopic ultrasound for the investigation of models of esophageal disease may offer insights for future translation to human imaging. With respect to small animal models of esophageal diseases, ultrasound imaging instrumentation must employ frequencies scaled up to maintain the compromise between image resolution and inspected region. In this sense, a 40-MHz endoluminal ultrasound biomicroscopy (eUBM) system and an endoscope were tested as diagnostic methods of imaging rat esophageal lesions in the acute and chronic phases caused by sodium hydroxide. Although endoscopy allowed grading of the esophagus in accordance with a classification specific to the epithelial alterations and including hyperemia, edema, exudates, fibrin and superficial and deep ulcerations, the eUBM images yielded the detection of superficial and deep ulcerations, as well as wall alterations caused by edema and inflammatory infiltrate in the submucosa. Additionally, eUBM enabled wall thickness measurements, which were statistically significantly increased (p < 0.05) in the acute phase.
Collapse
Affiliation(s)
- Rodrigo de Magalhães Gomes
- Post-Graduation Program in Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rossana C Soletti
- Pharmacy Unit, Universidade Estadual da Zona Oeste, Rio de Janeiro, Brazil
| | - Mônica Soldan
- Division of Gastroenterology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - Kalil Madi
- Division of Pathology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - F Stuart Foster
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - João C Machado
- Post-Graduation Program in Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Biomedical Engineering Program, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| |
Collapse
|
22
|
Gastric carcinoma: Evaluation with diffusion-tensor MR imaging and tractography ex vivo. Magn Reson Imaging 2016; 34:144-51. [DOI: 10.1016/j.mri.2015.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/20/2015] [Accepted: 10/17/2015] [Indexed: 01/20/2023]
|
23
|
Yamada I, Hikishima K, Miyasaka N, Kato K, Ito E, Kojima K, Kawano T, Kobayashi D, Eishi Y, Okano H. q-space MR imaging of gastric carcinoma ex vivo: Correlation with histopathologic findings. Magn Reson Med 2015; 76:602-12. [DOI: 10.1002/mrm.25905] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 07/26/2015] [Accepted: 08/03/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Ichiro Yamada
- Department of Diagnostic Radiology and Nuclear Medicine; Graduate School, Tokyo Medical and Dental University; Tokyo Japan
| | - Keigo Hikishima
- Department of Physiology; Keio University School of Medicine; Tokyo Japan
- Central Institute for Experimental Animals; Kanagawa Japan
| | - Naoyuki Miyasaka
- Department of Pediatrics, Perinatal and Maternal Medicine; Tokyo Medical and Dental University; Tokyo Japan
| | - Keiji Kato
- Department of Gastric Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Eisaku Ito
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Kazuyuki Kojima
- Department of Gastric Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Tatsuyuki Kawano
- Department of Esophageal Surgery; Tokyo Medical and Dental University; Tokyo Japan
| | - Daisuke Kobayashi
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoshinobu Eishi
- Department of Pathology; Tokyo Medical and Dental University; Tokyo Japan
| | - Hideyuki Okano
- Department of Physiology; Keio University School of Medicine; Tokyo Japan
| |
Collapse
|
24
|
Mocellin S, Pasquali S. Diagnostic accuracy of endoscopic ultrasonography (EUS) for the preoperative locoregional staging of primary gastric cancer. Cochrane Database Syst Rev 2015; 2015:CD009944. [PMID: 25914908 PMCID: PMC6465120 DOI: 10.1002/14651858.cd009944.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is proposed as an accurate diagnostic device for the locoregional staging of gastric cancer, which is crucial to developing a correct therapeutic strategy and ultimately to providing patients with the best chance of cure. However, despite a number of studies addressing this issue, there is no consensus on the role of EUS in routine clinical practice. OBJECTIVES To provide both a comprehensive overview and a quantitative analysis of the published data regarding the ability of EUS to preoperatively define the locoregional disease spread (i.e., primary tumor depth (T-stage) and regional lymph node status (N-stage)) in people with primary gastric carcinoma. SEARCH METHODS We performed a systematic search to identify articles that examined the diagnostic accuracy of EUS (the index test) in the evaluation of primary gastric cancer depth of invasion (T-stage, according to the AJCC/UICC TNM staging system categories T1, T2, T3 and T4) and regional lymph node status (N-stage, disease-free (N0) versus metastatic (N+)) using histopathology as the reference standard. To this end, we searched the following databases: the Cochrane Library (the Cochrane Central Register of Controlled Trials (CENTRAL)), MEDLINE, EMBASE, NIHR Prospero Register, MEDION, Aggressive Research Intelligence Facility (ARIF), ClinicalTrials.gov, Current Controlled Trials MetaRegister, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), from 1988 to January 2015. SELECTION CRITERIA We included studies that met the following main inclusion criteria: 1) a minimum sample size of 10 patients with histologically-proven primary carcinoma of the stomach (target condition); 2) comparison of EUS (index test) with pathology evaluation (reference standard) in terms of primary tumor (T-stage) and regional lymph nodes (N-stage). We excluded reports with possible overlap with the selected studies. DATA COLLECTION AND ANALYSIS For each study, two review authors extracted a standard set of data, using a dedicated data extraction form. We assessed data quality using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. We performed diagnostic accuracy meta-analysis using the hierarchical bivariate method. MAIN RESULTS We identified 66 articles (published between 1988 and 2012) that were eligible according to the inclusion criteria. We collected the data on 7747 patients with gastric cancer who were staged with EUS. Overall the quality of the included studies was good: in particular, only five studies presented a high risk of index test interpretation bias and two studies presented a high risk of selection bias.For primary tumor (T) stage, results were stratified according to the depth of invasion of the gastric wall. The meta-analysis of 50 studies (n = 4397) showed that the summary sensitivity and specificity of EUS in discriminating T1 to T2 (superficial) versus T3 to T4 (advanced) gastric carcinomas were 0.86 (95% confidence interval (CI) 0.81 to 0.90) and 0.90 (95% CI 0.87 to 0.93) respectively. For the diagnostic capacity of EUS to distinguish T1 (early gastric cancer, EGC) versus T2 (muscle-infiltrating) tumors, the meta-analysis of 46 studies (n = 2742) showed that the summary sensitivity and specificity were 0.85 (95% CI 0.78 to 0.91) and 0.90 (95% CI 0.85 to 0.93) respectively. When we addressed the capacity of EUS to distinguish between T1a (mucosal) versus T1b (submucosal) cancers the meta-analysis of 20 studies (n = 3321) showed that the summary sensitivity and specificity were 0.87 (95% CI 0.81 to 0.92) and 0.75 (95% CI 0.62 to 0.84) respectively. Finally, for the metastatic involvement of lymph nodes (N-stage), the meta-analysis of 44 studies (n = 3573) showed that the summary sensitivity and specificity were 0.83 (95% CI 0.79 to 0.87) and 0.67 (95% CI 0.61 to 0.72), respectively.Overall, as demonstrated also by the Bayesian nomograms, which enable readers to calculate post-test probabilities for any target condition prevalence, the EUS accuracy can be considered clinically useful to guide physicians in the locoregional staging of people with gastric cancer. However, it should be noted that between-study heterogeneity was not negligible: unfortunately, we could not identify any consistent source of the observed heterogeneity. Therefore, all accuracy measures reported in the present work and summarizing the available evidence should be interpreted cautiously. Moreover, we must emphasize that the analysis of positive and negative likelihood values revealed that EUS diagnostic performance cannot be considered optimal either for disease confirmation or for exclusion, especially for the ability of EUS to distinguish T1a (mucosal) versus T1b (submucosal) cancers and positive versus negative lymph node status. AUTHORS' CONCLUSIONS By analyzing the data from the largest series ever considered, we found that the diagnostic accuracy of EUS might be considered clinically useful to guide physicians in the locoregional staging of people with gastric carcinoma. However, the heterogeneity of the results warrants special caution, as well as further investigation for the identification of factors influencing the outcome of this diagnostic tool. Moreover, physicians should be warned that EUS performance is lower in diagnosing superficial tumors (T1a versus T1b) and lymph node status (positive versus negative). Overall, we observed large heterogeneity and its source needs to be understood before any definitive conclusion can be drawn about the use of EUS can be proposed in routine clinical settings.
Collapse
Affiliation(s)
- Simone Mocellin
- Meta-Analysis Unit, Department of Surgery,Oncology and Gastroenterology, University of Padova, Via Giustiniani 2, Padova, Veneto, 35128, Italy. .
| | | |
Collapse
|
25
|
Yamada I, Miyasaka N, Hikishima K, Kato K, Kojima K, Kawano T, Ito E, Kobayashi D, Eishi Y, Okano H. Gastric Carcinoma: Ex Vivo MR Imaging at 7.0 T-Correlation with Histopathologic Findings. Radiology 2015; 275:841-8. [PMID: 25584712 DOI: 10.1148/radiol.14141878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the imaging detail and diagnostic information that can be obtained at 7.0-T magnetic resonance (MR) imaging with a voxel volume of 9.5-14.0 nL as a means of evaluating the depth of mural invasion by gastric carcinomas ex vivo. MATERIALS AND METHODS This study was approved by the institutional review board, and written informed consent was obtained from each patient. Twenty gastric specimens containing 20 carcinomas were studied with a 7.0-T MR imaging system equipped with a four-channel surface coil. MR images were obtained with a 50-60 × 25-30 mm field of view, a 512 × 256 matrix, and a 1.0-mm section thickness, resulting in a voxel volume of 0.0095-0.0140 mm(3) (9.5-14.0 nL). The signal intensity of the gastric wall layers, tumor tissue, and fibrosis was described as low, intermediate, or high by comparing it with the signal intensity of the muscularis propria. Depth of invasion initially was assessed by two reviewers independently and then by the two reviewers in consensus. MR images were compared with histopathologic findings. RESULTS The 7.0-T T2-weighted MR images clearly depicted the normal gastric wall in all 20 specimens (100%) as consisting of seven layers, which clearly corresponded to the tissue layers of the gastric wall. These MR images enabled clear differentiation between tumor tissue and fibrosis. Reviewers disagreed on the depth of invasion at the initial reading in three (15%) of 20 specimens (between mucosa and submucosa in two specimens and between muscularis propria and subserosa and serosa in one specimen); however, in all 20 gastric carcinomas, the depth of invasion could be accurately determined on T2-weighted images after consensus interpretation. CONCLUSION Ex vivo 7.0-T MR imaging enables clear delineation of the gastric wall layers and clear differentiation of tumor tissue from fibrosis and allows one to assess the depth of mural invasion by gastric carcinomas.
Collapse
Affiliation(s)
- Ichiro Yamada
- From the Departments of Diagnostic Radiology and Oncology (I.Y.), Pediatrics, Perinatal and Maternal Medicine (N.M.), Gastric Surgery (K. Kato, K. Kojima), Esophageal Surgery (T.K.), and Pathology (E.I., D.K., Y.E.), Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; Department of Physiology, Keio University School of Medicine, Tokyo, Japan (K.H., H.O.); and Central Institute for Experimental Animals, Kawasaki, Japan (K.H.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Evaluation of the reliability of clinical staging of T2 N0 esophageal cancer: a review of the Society of Thoracic Surgeons database. Ann Thorac Surg 2013; 96:382-90. [PMID: 23731608 DOI: 10.1016/j.athoracsur.2013.03.093] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/21/2013] [Accepted: 03/22/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Clinical staging of esophageal cancer has improved with positron-emission tomography/computed tomography and endoscopic ultrasound imaging. Despite such progress, small single-center studies have questioned the reliability of clinical staging of T2 N0 esophageal cancer. This study broadly examines the adequacy of clinical staging of T2 N0 disease using The Society of Thoracic Surgeons database. METHODS We retrospectively studied 810 clinical stage T2 N0 patients from 2002 to 2011, with 58 excluded because of incomplete pathologic staging data. Clinical stage, pathologic stage, and preoperative characteristics were recorded. Logistic regression analysis was used to identify factors associated with upstaging at the time of surgical intervention. RESULTS Among 752 clinical stage T2 N0 patients, 270 (35.9%) received induction therapy before the operation. Of 482 patients who went directly to surgical intervention, 132 (27.4%) were confirmed as pathologic T2 N0, 125 (25.9%) were downstaged (ie, T0-1 N0), and 225 (46.7%) were upstaged at the operation (T3-4 N0 or Tany N1-3). Exclusive tumor upstaging (ie, pathologic T3-4 N0) accounted for 41 patients (18.2%), whereas exclusive nodal upstaging (ie, pathological T1-2 N1-3) accounted for 100 (44.5%). Combined tumor and nodal upstaging (ie, pathological T3-4 N1-3) accounted for 84 patients (37.3%). Among patients who received induction therapy, 103 (38.1%) were upstaged vs 225 (46.7%) without induction therapy (p = 0.026). Comparing the induction therapy group and the primary surgical group, postoperative 30-day mortality (3.7% vs 3.7%, p > 0.99) and morbidity (46.3% vs 45%, p = 0.76) were similar. CONCLUSIONS Despite advances in staging techniques, clinical staging of T2 N0 esophageal cancer remains unreliable. Recognizing T2 N0 as a threshold for induction therapy in esophageal cancer, many surgeons have opted to treat T2 N0 disease with induction therapy, even though one-quarter of these patients will be pathologic T1 N0. Although this study demonstrated similar perioperative morbidity and mortality with and without induction therapy, further study is needed to examine the effect of upstaging on long-term survival.
Collapse
|
27
|
Kato H, Nakajima M. Treatments for esophageal cancer: a review. Gen Thorac Cardiovasc Surg 2013; 61:330-5. [PMID: 23568356 DOI: 10.1007/s11748-013-0246-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Indexed: 01/15/2023]
Abstract
Esophageal cancer is the eighth most common form of cancer worldwide. The treatments for esophageal cancer depend on its etiology. For mucosal cancer, endoscopic mucosal resection and endoscopic submucosal dissection are standard, while for locally advanced cancer, esophagectomy remains the mainstay. The three most common techniques for thoracic esophagectomy are the transhiatal approach, the Ivor Lewis esophagectomy (right thoracotomy and laparotomy), and the McKeown technique (right thoracotomy followed by laparotomy and neck incision with cervical anastomosis). Surgery for carcinoma of the cervical esophagus requires an extensive procedure with laryngectomy in many cases. When the tumor is more advanced, neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is added. The theoretical advantages of adding chemotherapy to the treatment of esophageal cancer are potential tumor down-staging prior to surgery, as well as targeting micrometastases and, thus, decreasing the risk of distant metastasis. Cisplatin- and 5-fluorouracil-based regimes are used worldwide. Chemoradiotherapy is the standard for unresectable esophageal cancer and could also be considered as an option for resectable tumors. For patients who are medically or technically inoperable, concurrent chemoradiotherapy should be the standard of care. Although neoadjuvant chemoradiotherapy followed by surgery or salvage surgery after definitive chemoradiotherapy is a practical treatment; judicious patient selection is crucial. It is important to have a thorough understanding of these therapeutic modalities to assist in this endeavor.
Collapse
Affiliation(s)
- Hiroyuki Kato
- Department of Surgery I, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, 321-0293, Japan
| | | |
Collapse
|
28
|
The current state of diagnosis and treatment for early gastric cancer. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2013; 2013:241320. [PMID: 23533320 PMCID: PMC3600289 DOI: 10.1155/2013/241320] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 01/24/2013] [Indexed: 12/22/2022]
Abstract
The prognosis for gastric cancer depends on its stage; so, detection in the early stage of disease is important, when complete and curative removal is possible. Accurate diagnosis can be facilitated by a sound understanding of the basic findings of white light endoscopy of early gastric cancer, and diagnosis can be refined further by the combined use of other imaging modalities such as image-enhanced endoscopy including chromoendoscopy and endoscopic ultrasonography. Minimally invasive endoscopic treatment has come to be the preferred therapeutic approach for early gastric cancer. In addition to conventional endoscopic mucosal resection, a new technique known as endoscopic submucosal dissection (ESD) has spread rapidly worldwide. Indeed, strategies for ESD have been established, devices developed, its indications expanded, and its safety and long-term results extensively reported. Some unique combination therapies involving endoscopy and surgical treatment have also been reported. It is anticipated that the number of patients undergoing endoscopic therapy will continue to increase, and the ongoing developments in endoscopic treatment are expected not only to improve gastric cancer prognosis but also to maintain good quality of life after treatment.
Collapse
|