Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining: High‐grade intra‐epithelial neoplasia turns pink within a few minutes

Shimizu, Yuichi; Omori, Tai; Yokoyama, Akira; Yoshida, Takeshi; Hirota, Jojo; Ono, Yuji; Yamamoto, Junji; Kato, Mototsugu; Asaka, Masahiro

doi:10.1111/j.1440-1746.2007.04990.x

Cited by 118 publications

(89 citation statements)

References 21 publications

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“…After NBI examination, we switched back to WLI and sprayed 10 to 20 mL of 1.5% Lugol solution evenly over the mucosa from esophagogastric junction to upper esophagus. The criteria of suspected lesions were defined as a hyperemic change, uneven or nodularity of mucosa under WLI system (Figure 1A), or brownish discoloration of mucosa with abnormal epithelial capillary pattern (Inoue’s Classification type III ~ V) under NBI-ME system (Figure 1B and 1C) [9,10,16,17], or a well-demarcated Lugol-unstained area (Figure 1D) with a diameter greater than 5 mm or any Lugol-voiding lesions accompanied with pink-silver sign which is often associated with high-grade neoplasia [18]. Finally, the stomach, and the first and second portion of the duodenum, were examined under WLI using the typical panendoscopic procedure.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case–control study

Chung

Liao

et al. 2013

BMC Gastroenterol

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BackgroundThe prevalence of esophageal neoplasia in head and neck (H&N) cancer patients is not low; however, routine esophageal surveillance is not included in staging of newly-diagnosed H&N cancers. We aimed to investigate the risk factors for synchronous esophageal neoplasia and the impact of endoscopy on management of H&N cancer patients.MethodsA total of 129 newly diagnosed H&N cancer patients who underwent endoscopy with white-light imaging, narrow-band imaging (NBI) with magnifying endoscopy (ME), and chromoendoscopy with 1.5% Lugol’s solution, before definite treatment were enrolled prospectively.Results60 esophageal lesions were biopsied from 53 (41.1%) patients, including 11 low-grade, 14 high-grade intraepithelial neoplasia and 12 invasive carcinoma in 30 (23.3%) patients. Alcohol consumption [odds ratio (OR) 5.90, 95% confidence interval (CI) 1.23-26.44], advanced stage (stage III and IV) of index H&N cancers (OR 2.98, 95% CI 1.11-7.99), and lower body mass index (BMI) (every 1-kg/m2 increment with OR 0.87, 95% CI 0.76-0.99) were independent risk factors for synchronous esophageal neoplasia. NBI with ME was the ideal screening tool (sensitivity, specificity, and accuracy of 97.3%, 94.1%, and 96.3%, respectively, for detection of dysplastic and cancerous esophageal lesions). The treatment strategy was modified after endoscopy in 20 (15.5%) patients. The number needed to screen was 6.45 (95% CI 4.60-10.90).ConclusionsNBI-ME surveillance of esophagus should be done in newly-diagnosed H&N cancer patients, especially those with alcohol drinking, lower BMI, and advanced stage of primary tumor.

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Section: Methodsmentioning

confidence: 99%

Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case–control study

Chung

Liao

et al. 2013

BMC Gastroenterol

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“…Oesophageal HGD and carcinoma appear as non-stained areas with a pinkish colour with iodine-based chromoendoscopy 84. One observational study indicated that iodine chromoendoscopy improved lesion delineation in 88% of cases involving oesophageal HGD or SCC 85.…”

Section: Consensus Statementsmentioning

confidence: 99%

An Asian consensus on standards of diagnostic upper endoscopy for neoplasia

Chiu

Uedo²,

Singh

et al. 2018

Gut

118

103

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BackgroundThis is a consensus developed by a group of expert endoscopists aiming to standardise the preparation, process and endoscopic procedural steps for diagnosis of early upper gastrointestinal (GI) cancers.MethodThe Delphi method was used to develop consensus statements through identification of clinical questions on diagnostic endoscopy. Three consensus meetings were conducted to consolidate the statements and voting. We conducted a systematic literature search on evidence for each statement. The statements were presented in the second consensus meeting and revised according to comments. The final voting was conducted at the third consensus meeting on the level of evidence and agreement.ResultsRisk stratification should be conducted before endoscopy and high risk endoscopic findings should raise an index of suspicion. The presence of premalignant mucosal changes should be documented and use of sedation is recommended to enhance detection of superficial upper GI neoplasms. The use of antispasmodics and mucolytics enhanced visualisation of the upper GI tract, and systematic endoscopic mapping should be conducted to improve detection. Sufficient examination time and structured training on diagnosis improves detection. Image enhanced endoscopy in addition to white light imaging improves detection of superficial upper GI cancer. Magnifying endoscopy with narrow-band imaging is recommended for characterisation of upper GI superficial neoplasms. Endoscopic characterisation can avoid unnecessary biopsy.ConclusionThis consensus provides guidance for the performance of endoscopic diagnosis and characterisation for early gastric and oesophageal neoplasia based on the evidence. This will enhance the quality of endoscopic diagnosis and improve detection of early upper GI cancers.

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“…Shimizu et al [3] reported that HGIN could be identified as iodine-unstained areas that are more distinct and reddish than LGIN when the brown color of iodine solution in the normal region has faded after the staining. This is because there is almost no remaining glycogen-containing epithelium in HGIN.…”

Section: Lugol Chromoendoscopymentioning

confidence: 99%

“…Chromoendoscopy using iodine has been one of the most reliable diagnostic tools in detecting early SCC of the esophagus [3,4]. It has been effectively utilized not only in detecting, but also determining the local extent of the tumor.…”

Section: Introductionmentioning

confidence: 99%

Significance of Background Coloration in Endoscopic Detection of Early Esophageal Squamous Cell Carcinoma

Minami¹,

Isomoto

Inoue

et al. 2014

Digestion

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Endoscopic diagnostics of early squamous cell carcinoma (SCC) in the laryngo-esophageal region have dramatically improved together with development of less invasive endoscopic treatment. It is essential for gastrointestinal endoscopists to detect lesions when they are still endoscopically treatable, especially in this region since surgical approach can still be extremely invasive. Pioneers have found some notable fundamental alterations in early SCC and created several classifications. Inoue [Dig Endosc 2001;13(suppl): 40-41] proposed the intrapapillary capillary (IPCL) classification, which focused on the microvascular change of the mucosal surface. One of the significances of this classification is that it clearly distinguished the lesions that require further pathological evaluation by categorizing the diameter change of the IPCLs. On the other hand, Arima et al. [Esophagus 2005;2:191-197] advocated the alteration of microvessels as well as change of the vascular arrangement in the area. Most recently, the Japan Esophageal Society constructed a new classification uniting these two exemplary classifications as the ‘Japanese Classification of Magnifying Endoscopy for Early Squamous Cell Carcinoma'. This classification was intended to be simple and easily applicable in general clinical practice. Brownish color change between the IPCLs has reported to be one of the useful findings in distinguishing early SCC from benign changes such as inflammatory change and low-grade intraepithelial neoplasia. Nevertheless, the exact cause of this phenomenon remains unclear. We recently examined the association of color change with hemoglobin (Hb) in cancer tissue, since NBI exclusively detects the wavelength of Hb in superficial vessels in the gastrointestinal tract. This review article also describes our examination of a distinct finding in esophageal cancer, namely, ‘background coloration'.

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Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining: High‐grade intra‐epithelial neoplasia turns pink within a few minutes

Abstract: By using the pink-color sign for endoscopic diagnosis, accurate diagnosis without endoscopic biopsy for iodine-unstained areas was possible.

Cited by 118 publications

References 21 publications

Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case–control study

Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case–control study

An Asian consensus on standards of diagnostic upper endoscopy for neoplasia

Significance of Background Coloration in Endoscopic Detection of Early Esophageal Squamous Cell Carcinoma

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