Microvascular architecture of early esophageal neoplasia

Abstract

Abstract. Progress in magnifying endoscopy has allowed endoscopic atypia to be evaluated on the basis of the presence or the absence of microvascular hyperplasia in a tumor. We focused our attention on intra-epithelial papillary capillary loops (IPCLs) and studied 20 cases of esophageal neoplasia (IPCL type III, 10 cases; IPCL type IV, 10 cases) and 99 vessels (IPCL type III, 24 vessels; IPCL type IV, 75 vessels). We evaluated the histopathological findings and measured vessel caliber, distance from the basement membrane, distance between blood vessels and thickness of the epithelium. According to the Vienna classification, the histological findings in the 10 patients with IPCL type III lesions were classified as category 1 (negative for neoplasia/dysplasia) in 8 patients and category 3 (non-invasive low grade neoplasia) in 2 patients. The histological findings in the 10 patients with IPCL type IV lesions were classified as category 1 in 1 patient, category 3 in 4 patients and category 4 (non-invasive high grade neoplasia) in 5 patients. The vessel caliber of IPCL type IV lesions (mean, 5.9±2.7 µm) was significantly larger than that of IPCL type III lesions (mean, 4.8±1.5 µm) (P= 0.013). The distance from the basement membrane of IPCL type IV lesions (mean, 99.9±34.4 µm) was significantly greater than that of IPCL type III lesions (mean, 58.0±36.2 µm) (P=1.52562E -06 ). The distance between blood vessels and the thickness of the epithelium did not differ significantly between IPCL type III and IPCL type IV lesions. Our results revealed that changes in vessels of IPCL type IV lesions involve two factors: increased vessel caliber and prolongation of IPCLs toward the surface. These vascular changes appear to be associated with increased atypia of blood vessels. IntroductionIn category 3 of the Vienna classification (non-invasive low grade neoplasia-low grade adenoma/dysplasia), neoplasia is present, but it is associated with a low risk of progression to invasive carcinoma. Therefore, clinicians may consider local treatment of the lesion or opt for follow-up. In category 4 (noninvasive high grade neoplasia), the risks of invasion and the development of metastases are increased. Local treatment such as endoscopic mucosal resection or local surgical treatment is therefore indicated (1). Therefore, the ability to distinguish category 3 lesions from category 4 lesions endoscopically would be beneficial. We previously noted that category 3 and category 4 lesions differ with respect to changes in blood vessels, i.e., the formation of intra-epithelial papillary capillary loops (IPCLs) (2-4).Superficial blood vessels in the esophageal mucosa are branching vessels that extend horizontally immediately above the lamina muscularis mucosa. Intrapapillary capillaries arise from these branching vessels in epithelial papillae and form single loops referred to as IPCLs (Fig. 1). Branching vessels are observed as we approach the normal mucosa on conventional endoscopy. Using magnifying endoscopy with a scope which can magnify objects...

Endoscopic submucosal dissection for superficial esophageal neoplasms using the stag beetle knife

“…Subjects were retrospectively divided into the following two groups according to the type of knife used for ESD: the hook knife was used for 21 lesions from September 2006 to September 2009 (hook group), and the SB knife was used for 17 lesions from October 2009 onward (SB group). Indications for ESD included the following: (i) histological examination showing high‐grade intraepithelial neoplasms or squamous cell carcinoma; (ii) no lymph node involvement or distant metastasis observed on computed tomography (CT); (iii) no submucosal invasion observed on endosonography with through‐the‐scope endoscopic ultrasonography; and (iv) patterns of intrapapillary capillary loops observed under magnifying endoscopy (GIF‐Q240Z or GIF‐H260Z; Olympus Optical Co., Ltd, Tokyo, Japan) with narrow band imaging shown to be type IV or V1 and V2 . The lesion size was not an exclusion criterion.…”

“…Indications for ESD included the following: (i) histological examination showing high-grade intraepithelial neoplasms or squamous cell carcinoma; (ii) no lymph node involvement or distant metastasis observed on computed tomography (CT); (iii) no submucosal invasion observed on endosonography with through-the-scope endoscopic ultrasonography; and (iv) patterns of intrapapillary capillary loops observed under magnifying endoscopy (GIF-Q240Z or GIF-H260Z; Olympus Optical Co., Ltd, Tokyo, Japan) with narrow band imaging shown to be type IV or V1 and V2. 9,10 The lesion size was not an exclusion criterion. Written informed consent was obtained from all patients before esophageal ESD.…”

Background Coloration of Squamous Epithelium in Esophago-Pharyngeal Squamous Cell Carcinoma: What Causes the Color Change?

“…With the assistance of a narrow band imaging (NBI) system, magnifying endoscopy enables the clear visualization of fine mucosal architecture and microvasculature [1], [2]. Inoue et al reported the significance of intra-capillary papillary loop (IPCL) change including irregular dilation and caliber changes in diagnosing esophagopharyngeal squamous cell carcinoma (SCC) [3] [4] [5]. IPCL alteration is one of the earliest changes observed in superficial SCC.…”

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

“…This classification simply offers information of whether the pathological confirmation should be performed by differentiating type III and IV. Recently, Kaga et al [12] evaluated the detailed vascular structure pathologically and concluded that differences in vessels between IPCL type III and IV are highlighted by two factors: increased vessel caliber and prolongation of IPCLs toward the surface.…”