Difficulties in endoscopic estimation of depth of invasion in cases of superficial esophageal cancer
Momma, K.; Et-Al
Stomach and Intestine 39(6): 889-900
ISSN/ISBN: 0536-2180 Accession: 011960423
In cases with superficial esophageal cancer, we can employ today several advanced diagnostic measures such as endoscopic staining, ultrasonography and magnifying observation for estimation of cancer invasion. 402 cases of superficial esophageal cancer were included in this study in order to gauge the accuracy and recognize the difficulties in endoscopic estimation of cancer invasion. Esophagectomy was carried out on 142 cases and endoscopic mucosal resection on 260 cases. The incidence of misdiagnosis was noted in 15% of all cases (over estimation : 5.2% and under estimation : 9.7%). Type 0-IIc lesion is the most frequent among under estimated cases and type 0-I and 0-III the most frequent among cases with over estimation. Pathological studies on resected specimens of cases with under estimation revealed that endoscopic estimation of depth of invasion is difficult in cases with narrow cancer invasion into the deeper layer, cancer cell infiltration preserving normal tissue structures, deeper invasion of cancer cells with different histological type from covering squamous cell carcinoma and cancer tissue covered by regenerated stratified squamous epithelium. Some superficial esophageal cancers of protruded type were frequently over estimated as submucosal cancer when they had only papillary growth or poor tendency to invade into the deeper layer. We also encountered a few case which were estimated as submucosal cancers, but were actually mucosal cancers situated on top of benign submucosal tumors.