Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in linxian, china

Dawsey, Sanford M.; Fleischer, David E.; Wang, Guoqing; Zhou, Bin; Kidwell, Jean; Lü, Ning; Lewin, Klaus J.; Roth, Mark J.; Tio, T. L.; Taylor, Philip R.

doi:10.1002/(sici)1097-0142(19980715)83:2<220::aid-cncr4>3.0.co;2-u

Cited by 276 publications

(106 citation statements)

References 39 publications

(94 reference statements)

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“…We have previously shown that squamous dysplasia is the clinically important precursor lesion of ESCC in this highrisk Chinese population (23), squamous dysplasia (especially high-grade dysplasia) is usually endoscopically visible after mucosal iodine staining (25), which allows it to be targeted for biopsy and treatment, and high-grade dysplastic and early invasive lesions are usually treatable by focal endoscopic therapy (26). An accurate, cost-effective primary screening test that can identify patients with dysplastic or worse lesions who need endoscopy is still required for a clinically practical early detection and treatment program in such high-risk populations.…”

Section: Discussionmentioning

confidence: 99%

p16, MGMT, RARβ2, CLDN3, CRBP and MT1G gene methylation in esophageal squamous cell carcinoma and its precursor lesions

Roth¹,

Abnet²,

Hu³

et al. 2006

Oncol Rep

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Abstract. Esophageal squamous cell carcinoma (ESCC) is a common cancer with a very poor prognosis. New methods are needed to screen high-risk populations and identify curable tumors and precursor lesions early. Molecular markers may be useful in such screening efforts. This study was designed to determine the prevalence of p16, MGMT, RARß2, CLDN3, CRBP and MT1G gene methylation in patients with ESCC to evaluate the variation of gene methylation across a spectrum of preneoplastic lesions, and assess the feasibility of using gene methylation in a primary screening test utilizing frozen esophageal cells collected by balloon cytology samplers. Samples were obtained from high-risk subjects from north central China. These samples included 11 foci of histologically normal mucosa, 8 foci of low-grade squamous dysplasia, 7 foci of high-grade squamous dysplasia, and 13 foci of ESCC from 6 fully embedded resection specimens; endoscopic biopsies from 6 individuals with no histological evidence of disease; and frozen esophageal balloon samples from 12 asymptomatic subjects. Promoter CpG site-specific hypermethylation status was determined for each gene using realtime methylation-specific PCR (qMS-PCR) based on Taqman chemistry. Of the 6 ESCC patients, 5 showed methylation of at least one gene. For most genes, methylation occurred with increasing frequency during neoplastic progression, with the largest increase found between low-and high-grade dysplasia. There was considerable variation in methylation patterns among different foci of the same histological grade, even within individual patients, but 16/20 (80%) of high-grade dysplastic and cancer foci had ≥ 2 methylated genes, while 17/19 (89%) of normal and low-grade dysplastic foci had <2 methylated genes. These genes were rarely methylated in histologically normal mucosa from patients with or without ESCC. Gene methylation was common and easily detectable in the frozen esophageal cells collected by balloon cytology samplers. Our data suggest that methylation of p16, MGMT, RARß2, CLDN3, CRBP, and MT1G is common in the esophageal mucosa of patients with ESCC in this high-risk population, and tends to increase in prevalence in foci with increasing histological severity of disease. Methylation data from panels of genes may be able to identify patients with high-grade lesions. Balloon cytology may be able to screen the length of the esophagus effectively for a subset of cells with abnormal methylation, and may be useful in a primary screening test for ESCC and its precursor lesions.

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Section: Discussionmentioning

confidence: 99%

p16, MGMT, RARβ2, CLDN3, CRBP and MT1G gene methylation in esophageal squamous cell carcinoma and its precursor lesions

Roth¹,

Abnet²,

Hu³

et al. 2006

Oncol Rep

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“…The application of Lugol's iodine has been shown to improve visualisation of SCC and its pre-cancerous stage (Dawsey et al, 1998). Methylene blue has also been used to improve detection of dysplasia in Barrett's oesophagus, but subjectivity has meant results are difficult to reproduce (Ormeci et al, 2008), and there has been some concern over potential carcinogenicity of methylene blue (NTP, 2008).…”

Section: Chromoendoscopymentioning

confidence: 99%

Early diagnosis of oesophageal cancer

2009

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Squamous cell carcinoma and adenocarcinoma of the oesophagus are cancers that develop from distinct epithelial sub-types; however, they are both related to chronic inflammation of differing aetiologies. Inflammation leads to somatically inherited genetic mutations altering control of the cell cycle, DNA replication and apoptosis, which together result in autonomous and uncontrolled proliferation. These cancers have often metastasised to lymph nodes and distant organs before symptomatic presentation and therefore carry a poor prognosis. It is therefore vital to diagnose oesophageal cancer at an early stage, before the development of symptoms, when treatment can dramatically improve prognosis. Understanding the pathogenesis of these cancers is vital to guide early diagnostic strategies.

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“…It was reported that 27% of moderate/severe dysplasia of the esophagus were not identified in routine endoscopy examinations (6). In previous studies, Lugol chromoendoscopy was predominantly used in high-risk populations or high-risk regions to screen esophageal carcinomas or precancerous lesions (6,(13)(14)(15). The current study screens esophageal dysplasia/early carcinoma in low-risk regions using Lugol chromoendoscopy to evaluate whether Table V.…”

Section: Discussionmentioning

confidence: 92%

“…Lugol chromoendoscopy has been demonstrated to improve endoscopic visualization of squamous dysplasia and carcinoma of the esophagus in Linxian, a high-risk ESCC region in the Henan Province in China (6). However, the diagnostic value of Lugol chromoendoscopy in low-risk regions is unknown.…”

Section: Introductionmentioning

confidence: 99%

Lugol chromoendoscopic screening for esophageal dysplasia/early squamous cell carcinoma in patients with esophageal symptoms in low-risk region in China

Shao

et al. 2015

Oncology Letters

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Abstract. Detection of esophageal dysplasia/early esophageal squamous cell carcinoma (ESCC) is essential for improving 5-year survival. The aim of this prospective study was to evaluate whether Lugol chromoendoscopy improves the detection of esophageal dysplasia/early ESCC in patients with esophageal symptoms in a low-incidence region in China. Eligible patients were randomly assigned into two groups who received routine endoscopy or Lugol chromoendoscopy. During endoscopy, between one and five biopsies were taken from visible lesions for routine endoscopy, or unstained areas of >0.5 cm in diameter for Lugol chromoendoscopy. In total, 812 patients were enrolled, 395 for routine endoscopy and 417 for Lugol chromoendoscopy. The overall detection rate of esophageal dysplasia/early ESCC was 10.6% (86/812), the detection rates were 7.3% (29/395) and 13.7% (57/417) in routine and chromoendoscopy groups, respectively (χ 2 =8.58, P=0.003). The detection rates were 8.3% (48/580), 17.2% (17/99) and 16.5% (22/133), respectively, in patients with reflux, dysphagia and globus sensation symptoms. In the chromoendoscopy group, 213 patients had unstained lesions of >0.5 cm, the detection rates of dysplasia/early carcinoma were 5.3% (4/76) in those with lesions of 0.5-1.0 cm, and 37.2% (51/137) in those with lesions >1.0 cm (χ 2 =21.46, P<0.001). These results indicate that Lugol chromoendoscopy improves the detection rate of esophageal dysplasia/early carcinoma in patients with esophageal symptoms compared with routine endoscopy. We propose that Lugol chromoendoscopy must therefore be considered in addition to routine endoscopy in patients with esophageal symptoms.

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Mucosal iodine staining improves endoscopic visualization of squamous dysplasia and squamous cell carcinoma of the esophagus in linxian, china

Cited by 276 publications

References 39 publications

p16, MGMT, RARβ2, CLDN3, CRBP and MT1G gene methylation in esophageal squamous cell carcinoma and its precursor lesions

p16, MGMT, RARβ2, CLDN3, CRBP and MT1G gene methylation in esophageal squamous cell carcinoma and its precursor lesions

Early diagnosis of oesophageal cancer

Lugol chromoendoscopic screening for esophageal dysplasia/early squamous cell carcinoma in patients with esophageal symptoms in low-risk region in China

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