Evaluation of microvascular patterns of superficial esophageal cancers by magnifying endoscopy

Abstract

Background. Endoscopic findings have traditionally been evaluated on the basis of differences in color and changes in surface structure. We examined whether microvascular patterns on magnifying endoscopy could be used to diagnose benign and malignant superficial esophageal lesions and to estimate the depth of tumor invasion. Methods. Magnifying endoscopic findings were compared with histopathological features for 405 superficial lesions arising in the esophagus, including 191 esophageal cancers. Results. Microvascular patterns on magnifying endoscopy were classified into 4 types. Type 1 was characterized by thin, linear capillaries in the subepithelial papilla and was generally seen in normal mucosa. Type 2 was characterized by distended, dilated vessels, and the shape of capillaries in the subepithelial papilla was preserved. Type 2 was generally seen in inflammatory lesions. Type 3 was characterized by spiral vessels with an irregular caliber and crushed vessels with red spots, and the arrangement of the vessels was irregular. Type 3 was generally seen in m1 or m2 cancers. Type 4 was characterized by multilayered, irregularly branched, reticular vessels with an irregular caliber. Type 4 was generally seen in cancers with m3 or deeper invasion. Avascular areas (AVAs) and stretched type 4 vessels were seen in cancers with downward growth. The size of AVAs was closely related to the depth of tumor invasion. Conclusions. Histopathological features of superficial esophageal cancers can be diagnosed by evaluating microvascular patterns on magnifying endoscopy. The size of AVAs and associated type 4 vessels can be used to assess the extent and depth of tumor invasion.

Endoscopic Submucosal Dissection (ESD) with Additional Therapy for Superficial Esophageal Cancer with Submucosal Invasion

“…SM2 was evident in 55.9% and lym- phovascular involvements were detected in 39.5% of the patients. The accuracy of the diagnostic performance before ESD was 60.4%, which was lower than previous reports (22)(23)(24). The reason for the misdiagnosis of many cases in the present study was that the macroscopic appearance of the tumor influenced the tumor depth of invasion; it remains exceedingly difficult to differentiate between mucosal and sub-mucosal lesions.…”

The Efficacy of FDG-PET for the Management of Esophageal Cancer: Review Article

“…Recently, magnifying endoscopy has been used to determine tumor depth, as well. 26,27) It is difficult to judge the depth of invasion of esophageal cancer using FDG-PET. 10,28,29) Kato et al reported the detection rate of primary tumor for each depth of invasion (T1-T4).…”

A Case of Endocrine Cell Carcinoma Combined With Squamous Cell Carcinoma of the Esophagus Resected by Endoscopic Submucosal Dissection

“…1c), and IPCL type V -3 in IPCL classification by Inoue 2) in the elevated area (Fig. 1d), but it revealed no type 4R vessels corresponding to poorly differentiated carcinoma or specific histologic type of carcinoma in classification of microvascular pattern by Arima et al 3) IPCL type V -3 showed that the depth of tumor invasion was the muscularis mucosa or slight submucosa. Computer tomography (CT) of the chest and abdomen showed neither lymph node nor distant metastasis.…”

“…Similarly to our case, three of the four cases in which ER had been conducted failed to reach any diagnosis of ECC before the treatment, which suggests that a diagnosis of ECC before treatment is difficult. Arima et al 3) reported that lesions including the type 4R blood vessel, which does not form an avascular area according to classification of the microvascular pattern, includes a specific histologic type esophageal cancer such as ECC. Ozawa et al 5) reported one case observed using magnifying endoscopy with NBI as superficial esophageal ECC, which is described as appearing like type 4R.…”