Esophageal dysplasias are detected by endoscopy with Lugol in patients at risk for squamous cell carcinoma in southern Brazil

Abstract

Diagnosis of squamous cell carcinoma of the esophagus is usually late. Staining of the mucosa with Lugol's solution during endoscopy has been suggested to identify early cancer/dysplasia and may improve prognosis. Lugol was tested during endoscopy in 96 asymptomatic subjects at risk for this tumor, who were found to have atypias after exfoliative cytology in southern Brazil. Biopsies were obtained in Lugol's 'stained' and 'unstained' areas in the esophageal mucosa and the histologic results were compared. 'Unstained' areas were present in 64 (66.7%) instances: 44 'unstained' areas over mucosa with normal appearance revealed seven dysplasias (four high and three low grade), whereas 20 'unstained' areas with visible lesions contained only one dysplasia (low grade). 'Stained' areas in 96 (100%) subjects showed two additional dysplasias (one high and one low grade). In this study, Lugol 'unstained' areas were of great value for detection of dysplasias (sensitivity = 80%; specificity = 63%; p = 0.01, Fisher's exact test; CI = 95%; odds ratio = 6.7).

Oral premalignant lesions: from a clinical perspective

“…However, the diagnosis of epithelial dysplasia without invasive procedures is desirable. The efficacy of vital iodine staining for the diagnosis of cancer/dysplasia of the upper gastrointestinal tract has been evaluated in many studies [31][32][33][34]. Iodine staining for the oral mucosa ( Fig.…”

Colorimetric analysis of unstained lesions surrounding oral squamous cell carcinomas and oral potentially malignant disorders using iodine

“…The American Cancer Society has set a goal of reducing the morbidity of oral cancer by 25% in the US between 1992 and 2015 and has shown a drop from 12.0% to 10.7% (mean change per year: À0.9%) in its interim report 24 , but the 5-year survival rate has not improved in more than two decades 9 . In the case of malignant tumors, early detection and early treatment are important to improve the survival rates of patients with oral cancer.…”

Outcome of superficial squamous cell carcinoma of the esophagus: a clinicopathological study

“…. This wide range in incidence can be attributed in part to the pathological criteria used for the diagnosis of esophageal carcinoma and to the high number of endoscopies performed in asymptomatic individuals associated to the routine use of iodine staining (Lugol) which enhances the presence and extent of small malignant lesions in the esophageal mucosa, even those not visible radiologically and endoscopically [10][11][12][13] .…”

“…Endoscopically, it is often difficult to identify early superficial neoplastic lesions in the esophageal mucosa by conventional endoscopy, but application of iodine has been useful to enhance the detection of discrete neoplastic lesions [10][11][12][13] .…”