Endoscopic evaluation of depth of cancer invasion in cases with superficial esophageal cancer
Yoshida, M.; Momma, K.; Hanashi, T.; Izumi, Y.; Sakaki, N.
Stomach and Intestine 36(3): 295-306
ISSN/ISBN: 0536-2180 Accession: 010585073
Endoscopic evaluation of the depth of cancer invasion in cases with superficial esophageal cancer is important in selection of treatment. Lymph node metastasis is rare among cancers confined to the lamina propria mucosae. Therefore endoscopic mucosal resection (EMR) is recommended for them as the least invasive treatment. At the same time lymph node metastasis is frequent (44%) among submucosal cancers. Esophagectomy with lymph node dissection is recommended. The gross classification of superficial cancer works well for differentiation of submucosal cancers from mucosal cancers, such as 92% of superficial and protruded lesions (type 0-I) and 96% of superficial and depressed (type 0-III) lesions have submucosal invasion, while submucosal invasion is infrequent among lesions with superficial and flat type (type 0-II: 15%). At the same time, type 0-IIb lesions remained within the mucosa, but 15% of all type 0-IIa and 20% of type 0-IIc lesions have submucosal invasion (15% of all type 0-II lesions). Further evaluation of type 0-IIa and IIc lesions should be carried out. In cases with type 0-IIa, the size of the granular changes on the lesion should be analyzed. Fine granules suggest mucosal cancer and coarse granules suggest cancer invasion into the muscularis mucosae or the submucosa. In cases with type 0-IIc lesions, irregularities on the lesions suggest grade of invasion, e.g. flat or fine granular changes suggest mucosal cancer, coarse granular changes suggest invasion into the muscularis mucosae and nodular changes suggest invasion into the submucosa. Endoscopic double staining can differentiate mucosal cancer as pale a blue area with or without blue dots, spots or reticulation. Nodular changes in a type 0-IIc lesion and interruption of "Tataminome-folds" suggest cancer invasion into the muscularis mucosae or the submucosa. The overall accuracy rate in endoscopic estimation of cancer invasion was 81% (93% for mucosal cancer remaining within the lamina propria mucosae, 60% for invasion into the muscularis mucosae or slight invasion into the submucosa and 71% for moderate or massive invasion into the submucosa).