Miwako Arima

Serum p53 antibody is a useful tumor marker in superficial esophageal squamous cell carcinoma

Patients with superficial (mucosal or submucosal) esophageal carcinoma (SEC) have significantly better survival rates than patients with advanced carcinoma. Some patients with advanced esophageal carcinoma have been reported to test positive for serum p53 antibodies (Abs). Because very few patients with superficial carcinoma have been examined, the aim of this study was to evaluate the clinical significance of serum p53‐Abs in patients with superficial esophageal squamous cell carcinoma (SESCC).

Evaluation of microvascular patterns of superficial esophageal cancers by magnifying endoscopy

BackgroundEndoscopic findings have traditionally been evaluated on the basis of differences in color and changes in surface structure. We examined whether microvascular patterns on magnifying endoscopy could be used to diagnose benign and malignant superficial esophageal lesions and to estimate the depth of tumor invasion.MethodsMagnifying endoscopic findings were compared with histopathological features for 405 superficial lesions arising in the esophagus, including 191 esophageal cancers.ResultsMicrovascular patterns on magnifying endoscopy were classified into 4 types. Type 1 was characterized by thin, linear capillaries in the subepithelial papilla and was generally seen in normal mucosa. Type 2 was characterized by distended, dilated vessels, and the shape of capillaries in the subepithelial papilla was preserved. Type 2 was generally seen in inflammatory lesions. Type 3 was characterized by spiral vessels with an irregular caliber and crushed vessels with red spots, and the arrangement of the vessels was irregular. Type 3 was generally seen in m1 or m2 cancers. Type 4 was characterized by multilayered, irregularly branched, reticular vessels with an irregular caliber. Type 4 was generally seen in cancers with m3 or deeper invasion. Avascular areas (AVAs) and stretched type 4 vessels were seen in cancers with downward growth. The size of AVAs was closely related to the depth of tumor invasion.ConclusionsHistopathological features of superficial esophageal cancers can be diagnosed by evaluating microvascular patterns on magnifying endoscopy. The size of AVAs and associated type 4 vessels can be used to assess the extent and depth of tumor invasion.

Diagnostic accuracy of tumor staging and treatment outcomes in patients with superficial esophageal cancer

BackgroundWe examined the current status and diagnostic accuracy of currently available techniques for tumor staging and assessed treatment outcomes in patients with superficial esophageal cancer who received esophaguspreserving therapy, such as endoscopic mucosal resection (EMR) alone or combined with chemoradiotherapy (CRT).MethodsIn 274 patients with superficial esophageal cancer, we examined the depth of tumor invasion and the degree of lymph node metastasis by means of endoscopy, magnifying endoscopy, endoscopic ultrasonography (EUS), computed tomography (CT), and cervical and abdominal ultrasonography (US). We compared treatment outcomes among treatment groups according to the depth of tumor invasion.ResultsThe rates of correctly diagnosing the depth of tumor invasion were 89.6% on conventional endoscopy, 90.1% on magnifying endoscopy, and 85% on scanning with a high-frequency miniature ultrasonic probe (miniature US probe). Diagnostic accuracy for the m3 or sm1 cancers was poor. Magnifying endoscopy allowed invasion to be more precisely estimated, thereby improving diagnostic accuracy. However, lesions that maintained their surface structure despite deep invasion were misdiagnosed on magnifying endoscopy. A miniature US probe was useful for the assessment of such lesions. The diagnostic accuracy of EUS for lymph node metastasis was 83%, with a sensitivity of 76%. The sensitivity of CT was 29%, and that of cervical and abdominal US was 17%. Patients with m1 or m2 cancer had good outcomes after esophagus-preserving therapy. Although there were no significant differences in survival rates, many patients with sm2 or sm3 cancer who received CRT died of their disease. Nodal recurrence was diagnosed by EUS. In patients who received CRT, the time to the detection of recurrence was slightly prolonged.ConclusionsLong-term follow-up at regular intervals is essential in patients with m3 or sm esophageal cancers who receive esophagus-preserving treatment. At present, EUS is the most reliable technique for the diagnosis of lymph node metastasis and is therefore essential for pretreatment evaluation as well as for follow-up. Earlier detection of recurrence at a level that would potentially salvage treatment remains a topic for future research.

Endoscopic ultrasound-guided fine needle aspiration biopsy in esophageal and mediastinal diseases: Clinical indications and results

Background:  Endoscopic ultrasound‐guided fine needle aspiration biopsy (EUS‐FNAB) was developed to attain endosonographical images in real time in endoscopic biopsy, just like in percutaneous biopsy with ultrasonic or computer‐tomographical images. The results of EUS‐FNAB in esophageal and mediastinal diseases were evaluated and clinical indications of this technique were investigated.

Detection of Serum p53 Antibodies in Mucosal Esophageal Cancer and Negative Conversion After Treatment

Detection of Serum p53 Antibodies in Mucosal Esophageal Cancer and Negative Conversion After Treatment

MICROVASCULAR PATTERNS OF ESOPHAGEAL MICRO SQUAMOUS CELL CARCINOMA ON MAGNIFYING ENDOSCOPY

Background:  Recently, esophageal microcancers have been frequently diagnosed and are receiving increasing attention as initial findings of cancer. We examined whether the clinicopathological features and microvascular patterns of esophageal microcancers on magnifying endoscopy are useful for diagnosis.

Magnifying endoscopy in the diagnosis of Barrett's esophagus and Barrett's adenocarcinoma

Magnifying endoscopy with dye or acetic acid is useful for evaluating mucosal surface patterns in patients with Barretts epithelium. Barretts epithelium can be diagnosed on the basis of the presence of translucent longitudinal vessels. Specialized intestinal metaplasia frequently occurs in villous- or gyrus-type mucosa. Superficial Barretts adenocarcinoma is associated with irregularities or destruction of mucosal surface patterns. Magnifying endoscopy combined with optical chromoendoscopy by new techniques for enhancement of vascular images, such as narrow-band imaging (NBI) and Fuji intelligent color enhancement (FICE), may further improve diagnostic accuracy. Irregularly arranged abnormal vessels appear in cancerous lesions. However, classification systems for characteristic vascular patterns have not been established. Whether vascular patterns are useful for diagnosing cancers with mild atypia remains an open question.

A feasibility study of chemosensitivity assay by adhesive tumor cell culture system using biopsy specimens for gastric cancer

The adhesive tumor cell culture system (ATCCS) is known to produce high colony‐forming efficiency. We, therefore, studied the feasibility of ATCCS for gastric cancer by use of biopsy specimens and the relationship between the results of ATCCS and histological effects of anticancer drugs.

7052 Endoscopic ultrasound-guided fine needle aspiration biopsy for lesions of upper digestive tract.

[Purpose] EUS-guided fine needle aspiration biopsy (EUS-FNAB) is a new technique for tissue sampling intraluminal or extra luminal lesions. In 1994 we developed a revised linear-type EUS device which has a special channel for puncture, and have also devised an Endosonopsy needle. We examined about the indication and the problem of EUS-FNAB for the cases of upper digestive tract. [Subjects and Methods] We used the lineartype EUS PEF-703FA (Toshiba -Fujinon Co.) and the Endosonopsy needle (Hakko Co.).We have used these devices in 57 cases to biopsy, submucosal tumor (SMT) of the esophagus 7, esophageal stenosis or compression 8, mediastinal lymph node 10, SMT of the stomach 23, thickened gastric folds 4, retroperitoneal tumors 3 and abdominal lymphnode 2. [Results] Adequate specimen samples were obtained in 51 cases (89%) of the cases. Accurately diagnosed malignant cases were 22 during 25 cases (for example leiomyosaocoma, leiomyoblastoma, lung cancer, metastatic mediastinal lymph node and gastric cancer). And the sensitivity for malignancy was 88%, specificity was 100% and the diagnostic accuracy was 94%. The moving targets, fibrous gastric wall thickness and necrotic tumors were difficult to take the specimens. And we have experienced no fatal complications. [Discussion] EUS-FNAB is a more safe and accurate method compared with conventional US or CT-guided FNA. It is helpful in the diagnosis of small lesions and mediastinal diseases, where tissue sampling is more difficult using the conventional methods. The puncture for the mediastinal lymph node of the superficial esophageal cancer is especially useful for indicating the endoscopic mucosal resection (EMR) and follow up study after EMR. Color doppler imaging was used to select the safest puncture route. [Conclusion] EUS-FNAB may have significant clinical use in the diagnosis of SMT and in the selection of therapy for patients with gastrointestinal and mediastinal malignancies.

A Detailed Survey of Superficial Esophageal Cancer with Histological Features Other than Squamous Cell Carcinoma in Japan

Abstract: A questionnaire‐based survey of cases of superficial esophageal cancer with histological features other than squamous cell carcinoma (SCC) was conducted prior to The 37th Conference of the Japanese Research Society for Early Esophageal Cancer and Chromoendoscopy. The data of cases resected between 1986 and 1996 at 25 Japanese institutions were evaluated. Among 2,381 cases of superficial esophageal cancer, 93 patients (3.9%) were diagnosed with histological features other than SCC. These included 6 cases of mucosal cancer and 87 cases of submucosal cancer, and were referred to as superficial nonsquamous cell carcinoma (NSCC). Most cases were grossly classified as O‐I type. Elevated tumors, which included O‐I and O‐lla types, accounted for 80% of all lesions. Many cases of adenoid cystic carcinoma (ACC), adenosquamous carcinoma (ASC), basaloid carcinoma (BSC) and undifferentiated carcinoma (UND) were classified as O‐lpl or O‐lsep types. Almost all cases of carcinosarcoma (CASA) and malignant melanoma (MM) were classified as O‐lp type. A small number of O‐llc type tumors were observed and diagnosed as adenocarcinoma (AC), ACC ASC and BSC. All cases of AC were classified as unilocular tumor, and many cases were observed at the abdominal esophagus. However, the superficial esophageal tumors could not be differentiated by endoscopic features. The frequency of lymph node metastasis was slightly higher in UND and MM (60%), while the other histological types of esophageal cancer had an equivalent frequency to SCC (20–40%). Although the frequency of tumor recurrence was usually approximately 20%, the frequency of recurrent UND and MM was as high as 50–60%. Distant organ metastasis was the most commonly observed pattern of tumor metastasis. The five‐year survival rate was approximately 60%, and there were no significant differences in the survival rate among the patients. However, the prognosis of UND and MM tended to be poor. (Dig Endosc 1999; 11: 12–23)