Size of Lugol-unstained lesions as a predictor for risk of progression in premalignant lesions of the esophagus

Larger esophageal Lugol’s unstained lesions need more follow-up: size as an important predictor for risk of premalignant lesions

“…It has been previously shown that there is a positive relation between LUL size 3 or multiplicity 9 and the presence of SDA, and this has led to the recommendation that endoscopic therapy be performed on LULs with these "worrisome" endoscopic features and a biopsy diagnosis of moderate dysplasia, and also in all LULs with biopsy specimens showing SDA. 10 The current study by Liu et al 7 confirms the importance of special consideration for larger lesions and the importance of trusting clinical judgement when biopsy diagnoses (eg, no dysplasia) do not match the endoscopic impression (a large LUL). As noted in the current article, additional studies in general populations are needed to confirm the findings of this study, to highlight potential screening pitfalls (eg, large lesions with biopsy diagnoses of no dysplasia), to improve our triage of patients to surveillance, and to optimize surveillance intervals based on both LCE findings and pathologic diagnoses.…”

“…5B in the authors' earlier article 8 ), and new lesions can develop in this exposure field in different locations over time (certainly within 5.8 years of follow-up). We think it is probable that most of the increased risk of progression with LUL size found in patients with initial biopsy diagnoses of no dysplasia or mild dysplasia in the current study by Liu et al 7 resulted from a combination of the initial biopsies missing the targeted lesion, biopsy sampling error in larger lesions, and the later diagnoses of SDAs developing in a different site than the initial lesion. But all 3 of these situations occur, especially in rapid screening endoscopies, so it is important to be aware of the potential importance of lesion attributes (such as size) other than biopsy diagnoses.…”

“…Liu et al 7 found that in 46 (4.3%) of the 1058 study participants, an SDA lesion developed over a median follow-up period of 5.8 years. Stratified by initial pathologic diagnosis, 2.7% of the subjects with no dysplasia, 7.3% of those with mild dysplasia, and 22.0% of those with moderate dysplasia experienced SDA.…”

“…In addition, several details that are important for understanding the protocol and the results of the study were not given. In the initial baseline endoscopic examinations, when a patient had >1 lesion, Liu et al 7 did not mention how it was decided which lesion was used to characterize the patient's endoscopic features and histologic diagnosis, and when a lesion had >1 biopsy, which biopsy diagnosis was used to characterize the lesion. In addition, when >1 biopsy specimen was taken from an individual, it was unclear whether or not there was a standard protocol (eg, 1 biopsy for lesions 5 mm, 2 biopsies for lesions 6 to 10 mm).…”

Optical Biopsy for Esophageal Squamous Cell Neoplasia by Using Endocytoscopy

“…We evaluated ECS based on the EC classi cation [18] described below (Video 1). Lesions less than 5 mm in size were excluded from the study because it has been reported that these lesions are rarely cancerous [19,20].…”