Histologic results of EMR for esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by endoscopic biopsy

Shimizu, Yuichi; Kato, Mototsugu; Yamamoto, Junji; Ono, Yuji; Katsurada, Takehiko; Ono, Shouko; Mori, Yusaku; Nakagawa, Manabu; Nakagawa, Souichi; Itoh, Tomoo; Asaka, Masahiro

doi:10.1016/j.gie.2005.09.027

Cited by 38 publications

(28 citation statements)

References 25 publications

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“…If the BA was stained, we obtained biopsy specimens from lesions with a well-demarcated BA on NM-NBI after removing the staining with sodium thiosulfate solution. Thirteen lesions with typical endoscopic findings were treated with ER without prior biopsy (26). All of these lesions were treated with endoscopic submucosal dissection because endoscopic submucosal dissection is more efficient for achieving en bloc resection of the lesion (27).…”

Section: Methodsmentioning

confidence: 99%

Usefulness of Non-Magnifying Narrow-Band Imaging in Screening of Early Esophageal Squamous Cell Carcinoma: A Prospective Comparative Study Using Propensity Score Matching

Nagami

Tominaga

Machida³

et al. 2014

American Journal of Gastroenterology

117

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OBJECTIVES:The usefulness of non-magnifying endoscopy with narrow-band imaging (NBI; NM-NBI) in the screening of early esophageal squamous cell carcinoma (SCC) and high-grade intraepithelial neoplasia (HGIN) remains unclear. Here, we aimed to compare NM-NBI and chromoendoscopy with iodine staining (CE-Iodine) in terms of the diagnostic performance, and to evaluate the usefulness of NM-NBI in detecting early esophageal SCC.METHODS:We prospectively enrolled 202 consecutive patients (male/female=180/22; median age, 67 years) with high-risk factors for esophageal SCC. All patients received endoscopic examination with NM-NBI and CE-Iodine to screen for early esophageal SCC or HGIN. We conducted the examinations sequentially, and calculated the accuracy, sensitivity, and specificity through a per-lesion-based analysis. A propensity score matching analysis was performed to reduce the effects of selection bias, and we compared the respective outcomes according to NM-NBI and CE-Iodine after matching.RESULTS:The accuracy, sensitivity, and specificity of NM-NBI were 77.0, 88.3, and 75.2%, respectively, and those for unstained areas by CE-Iodine were 68.0, 94.2, and 64.0, respectively. The accuracy and specificity of NM-NBI were superior to those of CE-Iodine (P=0.03 and P=0.01, respectively). However, the sensitivity did not significantly differ between NM-NBI and CE-Iodine (P=0.67). The accuracy and specificity of NM-NBI before matching were superior to those of CE-Iodine after matching (P=0.04 and P=0.03).CONCLUSIONS:NM-NBI was useful and reliable for the diagnosis of esophageal SCC and can be a promising screening strategy for early esophageal SCC.

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Section: Methodsmentioning

confidence: 99%

Usefulness of Non-Magnifying Narrow-Band Imaging in Screening of Early Esophageal Squamous Cell Carcinoma: A Prospective Comparative Study Using Propensity Score Matching

Nagami

Tominaga

Machida³

et al. 2014

American Journal of Gastroenterology

117

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“…This may explain the higher proportion of early squamous cell carcinoma and relatively good prognosis of superfi cial esophageal carcinoma in Japan. 43 To resolve the different pathological criteria between Japan and the West, the Vienna classifi cation was developed (Table 1), 41,42 improving interobserver agreement for conditions of the gastrointestinal tract. Subsequently, the revised Vienna classifi cation ( Table 2) was proposed, although it has not been widely adopted.…”

Section: Pathological Fi Ndings Of Squamous Intraepithelial Neoplasiamentioning

confidence: 99%

Squamous intraepithelial neoplasia of the esophagus: past, present, and future

et al. 2009

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With regard to the esophagus, the term "squamous dysplasia" has been used in European countries, the United States, and China, while its use is controversial in Japan. Recently, "low-grade intraepithelial neoplasia" and "high-grade intraepithelial neoplasia" have been used as inclusive terms for dysplasia and carcinoma in situ in the World Health Organization classification. Endoscopically, it is often difficult to identify squamous intraepithelial neoplasia by conventional endoscopy, but application of iodine is useful for the diagnosis of such a lesion. In addition, new types of endoscopic techniques, including magnifying endoscopy, narrow-band imaging (NBI), and endocytoscopy are helpful to detect squamous intraepithelial neoplasia. NBI is very useful for identifying the intrapapillary capillary loop pattern. Regarding the pathological criteria of squamous dysplasia and squamous cell carcinoma, the views of Japanese and Western pathologists have differed significantly. Before the term "intraepithelial neoplasia" was introduced, severe dysplasia as diagnosed by Western pathologists was in fact the same as squamous cell carcinoma in situ or noninvasive carcinoma as diagnosed by Japanese pathologists. This problem has been solved by the introduction of the Vienna classification; however, there are still some issues that need to be resolved. One of them is the presence of basal layer type squamous cell carcinoma in situ, which is often underdiagnosed as lowgrade intraepithelial neoplasia by Western pathologists. Endoscopic treatments such as endoscopic mucosal resection and endoscopic submucosal dissection have recently become possible choices for squamous intraepithelial neoplasia; however, these techniques are not in widespread use in the West. We believe that a consensus meeting between Japanese and Western pathologists as well as endoscopists should be held promptly to reach a common ground for the nomenclature.

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“…It is still controversial whether to treat these neoplasms endoscopically or to follow them. However, when the lesions are diagnosed as high-grade intraepithelial neoplasms, endoscopic treatment is recommended for future development of invasive carcinoma or tumors containing foci of invasive carcinoma [12,13]. Esophageal squamous cell carcinomas invading the lamina propria (T1a-LPM) have also little possibility of nodal metastasis.…”

Section: Indications For Esdmentioning

confidence: 99%

Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma

Fujishiro

Kodashima

2009

Esophagus

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Endoscopic submucosal dissection (ESD) has gradually gained acceptance as one of the standard treatments for esophageal squamous cell carcinoma in Japan. Principal indications are little likelihood of nodal metastasis and having technical resectability. All lesions with preoperative diagnosis of high-grade intraepithelial neoplasms, including carcinomas in situ (T1a-EP), carcinomas invading the lamina propria (T1a-LPM), and some with preoperative diagnosis of carcinomas invading the muscularis mucosa (T1a-MM) and minute submucosal invasion (T1b-SM1), may become candidates for ESD, considering the substantial risks and benefi ts to be obtained. ESD as a staging measure to obtain histological confi rmation of invasion depth and lymphovascular infi ltration may be acceptable because preoperative prediction is diffi cult in some cases. In terms of technique, advantages of ESD in comparison with other endoscopic treatment are controllability in size and shape, and that even large and fi brotic neoplasms can be resected. Disadvantages may be longer procedure time, heavier bleeding, and greater possibility of perforation. However, with refi nement of the technique, new devices, and the learning curve, acceptable technical safety has been achieved. Our experience with 104 consecutive cases shows favorable outcomes, although further innovation may be necessary. We are convinced that ESD will become a standard treatment for early-stage esophageal squamous cell carcinoma not only in Japan but also all over the world in the near future.

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Histologic results of EMR for esophageal lesions diagnosed as high-grade intraepithelial squamous neoplasia by endoscopic biopsy

Cited by 38 publications

References 25 publications

Usefulness of Non-Magnifying Narrow-Band Imaging in Screening of Early Esophageal Squamous Cell Carcinoma: A Prospective Comparative Study Using Propensity Score Matching

Usefulness of Non-Magnifying Narrow-Band Imaging in Screening of Early Esophageal Squamous Cell Carcinoma: A Prospective Comparative Study Using Propensity Score Matching

Squamous intraepithelial neoplasia of the esophagus: past, present, and future

Indications, techniques, and outcomes of endoscopic submucosal dissection for esophageal squamous cell carcinoma

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