| Theme |
Early Esophageal cancer-from the Viewpoint of its Type and the Depth of Invasion |
| Title |
Endoscopic Evaluation of Cancer Invasion into the Esophageal Wall in Cases with Mucosal Cancers of the Esophagus -Application of Endoscopic Staining Techniques- |
| Author |
Misao Yoshida |
Department of Surgery,Tokyo Metropolitan Komagome General Hospital |
| Author |
Kumiko Momma |
Gastroenterology,Tokyo Metropolitan Komagome General Hospital |
| [ Summary ] |
Mucosal cancers of the esophagus could be classified into three types (0-IIa : slightly elevated type, 0-IIb : flat type and 0-IIc : slightly depressed type). Detection had been difficult because these cancers showed minimal abnormalities on endoscopy.
The endoscopic iodine staining technique can delineate a mucosal cancer as a yellowish-white unstained area against dark brown normal mucosa, facilitating endoscopic detection. Most type 0-IIa lesions are mucosal cancers and 0-IIb lesions intraepithelial cancers. Type 0-IIc lesions are most frequent among mucosal cancers and the depth of cancer invasion is distributed from the epithelium, and the lamina propria mucosae to the submucosa. The endoscopic toluidine blue-iodine double staining technique provided precise differentiation of cancers confined to the epithelium (pale blue, passing fine transversal mucosal folds), the lamina propria mucosae (dark blue dots or reticular staining in the unstained area) and the muscularis mucosae (shallow, distinct depression with coarse granular changes which could stain dark blue. Fine transversal mucosal folds were interrupted at their margin). In cases with type 0-IIc mucosal cancers confined to the epithelium and the lamina propria mucosae, the accuracy rate in estimating cancer invasion was 96 %. |