Endoscopic Criteria for Invasive Depth of Superficial Esophageal Cancer

Abstract

The therapeutic strategy for superficial esophageal cancer should be determined by the depth of invasion. Therefore, we endeavored to develop reliable criteria for endoscopic evaluation of the invasive depth of superficial esophageal cancer. Two hundred and fifty nine superficial squamous cell carcinoma cases were enrolled in this study, designed to investigate the relationship between endoscopic classification and the depth of invasion, and also between lesion size and depth of invasion. Almost all 0-1, 0-I+O-llc, 0-llc+O-lla and 0-111 lesions invaded the submucosal layer, although 0-lla and 0-llb lesions were limited to the mucosal layer. The 0-llc type of lesion showed a wide range of invasive depths from M1 to SM3 ; in M1 cases with minimal depression the surface appears entirely smooth ; in M2 cases the depressed surface is uniformly granular ; and M3 cases have slightly larger granules. With submucosal cancer, the depressed surface showed some irregularity and variability in granule size. In the 0-llc type, 100% of lesions under 1 0 mm and 80% of those under 30 mm in greatest dimension were mucosal cancer. The accuracy of our criteria for endoscopically evaluating the depth of invasion was 80.2%. The accuracy rate, in terms of assignment to group M1 and M2, M3 and SM1, or SM2 and SM3, was 90.6%. (Dig Endosc 1997;9:110-115) words : endoscopic evaluation of depth of invasion, superficial esophageal cancer, depth of invasion, preoperative diagnosis Manuscript

Vertical and horizontal growth features of superficial esophageal squamous cell carcinomas: histopathological evaluation of endoscopically resected specimens

“…It has been estimated that invasion depth is accurately diagnosed preoperatively in 60-80% of patients by Japanese experts [10,17]. However, differentiation between m3 and sm carcinomas is difficult, with accuracy dropping below 60% [10].…”

“…Endoscopists can contribute by examining height of elevation, depth of depression, and surface features [10]. It has been estimated that invasion depth is accurately diagnosed preoperatively in 60-80% of patients by Japanese experts [10,17].…”

Esophageal Squamous Cell Carcinoma with Lymphoid Stroma: Histopathological and Immunohistochemical Analysis

“…In Japan, squamous cell carcinoma is the most common malignancy of the esophagus. However, prominent lymphocytic infiltration is extremely rare in esophageal squamous cell carcinoma 1) . This present case was unique in the prominent stromal lymphocytic infiltration around the carcinoma cells.…”

“…The tumor (longitudinal size, 1.5 cm) was located on the posterior wall of the middle thoracic esophagus (Fig.1A, B). Endoscopic examination revealed a protruding tumor with a central depression, covered by normal-appearing esophageal epithelium stained with iodine but not with toluidine blue, resembling a submucosal tumor, 30 cm Department of Surgery 1) and Pathology 2) , Tokai University School of Medicine from the incisor teeth ( Fig. 2A, B).…”

“…Squamous cell carcinoma is the most common malignancy of the esophagus 1) , and although lymphoid stroma of neoplastic lesions has been reported in different organs such as the breast, nasopharynx, uterine cervix and stomach, prominent lymphocytic infiltration around tumor cells is extremely rare in esophageal carcinoma [2][3][4][5][6][7][8] . Lymphocytic infiltration is thought to represent a host immune reaction against tumor cells, and its prognostic significance has been well documented in human cancers [9][10][11] .…”