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      Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society

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          Abstract

          Predicting invasion depth of superficial esophageal squamous cell carcinoma is crucial in determining the precise indication for endoscopic resection because the rate of lymph node metastasis increases in proportion to the invasion depth of the carcinoma. Previous studies have shown a close relationship between microvascular patterns observed by Narrow Band Imaging magnifying endoscopy and invasion depth of the superficial carcinoma. Thus, the Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating invasion depth of superficial esophageal squamous cell carcinomas. We conducted a prospective study to evaluate the diagnostic values of type B vessels in the pretreatment estimation of invasion depth of superficial esophageal squamous cell carcinomas utilizing JES classification, the criteria of which are based on the degree of irregularity in the microvascular morphology. Type A microvessels corresponded to noncancerous lesions and lack severe irregularity; type B, to cancerous lesions, and exhibit severe irregularity. Type B vessels were subclassified into B1, B2, and B3, diagnostic criteria for T1a-EP or T1a-LPM, T1a-MM or T1b-SM1, and T1b-SM2 tumors, respectively. We enrolled 211 patients with superficial esophageal squamous cell carcinoma. The overall accuracy of type B microvessels in estimating tumor invasion depth was 90.5 %. We propose that the newly developed JES magnifying endoscopic classification is useful in estimating the invasion depth of superficial esophageal squamous cell carcinoma.

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          Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma.

          Long-term outcomes after endoscopic resection (ER) provide important information for the treatment of esophageal carcinoma. This study aimed to investigate the rates of survival and metastasis after ER of esophageal carcinoma. From 1995 to 2010, 570 patients with esophageal carcinoma were treated by ER. Of these, the 402 patients with squamous cell carcinoma (280 epithelial (EP) or lamina propria (LPM) cancer, 70 muscularis mucosa (MM) cancer, and 52 submucosal (SM) cancer) were included in our analysis. Seventeen patients had cancer invading into the submucosa up to 0.2 mm (SM1) and 35 patients had cancer invading into the submucosa more than 0.2 mm (SM2). The mean (range) follow-up time was 50 (4-187) months. The 5-year overall survival rates of patients with EP/LPM, MM, and SM cancer were 90.5, 71.1, and 70.8%, respectively (P=0.007). Multivariate analysis identified depth of invasion and age as independent predictors of survival, with hazard ratios of 3.6 for MM cancer and 3.2 for SM cancer compared with EP/LPM cancer, and 1.07 per year of age. The cumulative 5-year metastasis rates in patients with EP/LPM, MM, SM1, and SM2 cancer were 0.4, 8.7, 7.7, and 36.2%, respectively (P<0.001). Multivariate analysis identified depth of invasion as an independent risk factor for metastasis, with hazard ratios of 13.1 for MM, 40.2 for SM1, and 196.3 for SM2 cancer compared with EP/LPM cancer. The cumulative 5-year metastasis rates in patients with mucosal cancer with and without lymphovascular involvement were 46.7 and 0.7%, respectively (P<0.0001). The long-term risk of metastasis after ER was mainly associated with the depth of invasion. This risk should be taken into account when considering the indications for ER.
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            Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan.

            Histopathologic characteristics and optimal treatment modality for superficial esophageal cancer were reevaluated on the basis of 2418 patients from 143 institutions through a nationwide questionnaire to the members of the Japanese Society for Esophageal Diseases. A questionnaire was designed for patients with preoperatively untreated superficial cancer of the esophagus who had undergone either surgical or endoscopic treatment between January 1, 1990, and December 30, 1994. Mucosal cancer and submucosal cancer were divided into three subclasses according to the criteria formulated by the Society. The incidence of positive lymphatic invasion or lymph node metastases tended to increase markedly as cancer infiltrates reached the lamina muscularis mucosa. The majority of the cases with 0-I or 0-III components were submucosal cancer. The indication of endoscopic mucosal resection (EMR) was limited to mucosal 1 and mucosal 2 superficial cancer in 76% of the institutions surveyed. Tumors measuring 2 cm or more in diameter were resected piecemeal in 94% of patients. Complications of EMR, including perforation, stenosis, and hemorrhage, were observed in approximately 6.8% of patients. Almost all patients with mucosal 1 or mucosal 2 cancer are still alive. There was no significant difference in prognosis between mucosal 3 cancer and mucosal 1 or mucosal 2 cancer, but submucosal 1 cancer showed worse prognosis than mucosal cancer. Local resection of cancer lesions is regarded as the treatment of choice against the superficial esophageal cancers limited to the lamina propria mucosae. Further study is advocated to define the treatment strategy against mucosal 3 or submucosal 1 cancer.
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              Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distal metastasis.

              Endoscopic mucosal resection (EMR) is a less invasive localized treatment for patients with esophageal carcinoma. However, indications for EMR use in cases of superficial esophageal carcinoma are controversial. The authors evaluated histopathologic risk factors for lymph node metastasis and recurrence. In the specimens resected, the authors examined depth, the superficial area and the area attached to or infiltrating the lamina muscularis mucosa. The authors found that the superficial area and the attached or infiltrated area reflected the depth of the tumor. However, there was a recurrence of esophageal carcinoma even in m3 cases attached only to the lamina muscularis mucosa. The authors concluded that ml and m2 esophageal carcinoma had almost no risk of lymph node metastasis and recurrence no matter how extensive the superficial area. In addition, sm2 and sm3 carcinoma have a high frequency of lymph node metastasis and recurrence. M3 and sm1 carcinoma run the risk of lymph node metastasis and recurrence however small the superficial area and the area attached to or infiltrating the lamina muscularis mucosa. Treatment strategies for patients with superficial esophageal carcinoma, including EMR, should take the above findings into account.
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                Author and article information

                Contributors
                +81-3-3433-1111 , kengoendoscopy@hotmail.co.jp
                Journal
                Esophagus
                Esophagus
                Esophagus
                Springer Japan (Tokyo )
                1612-9059
                1612-9067
                6 April 2016
                6 April 2016
                2017
                : 14
                : 2
                : 105-112
                Affiliations
                [1 ]ISNI 0000 0000 8962 7491, GRID grid.416751.0, Department of Endoscopy, , Saku Central Hospital Advanced Care Center, ; Nagano, Japan
                [2 ]ISNI 0000 0000 8864 3422, GRID grid.410714.7, Digestive Disease Center, , Showa University Koto Toyosu Hospital, ; Tokyo, Japan
                [3 ]ISNI 0000 0000 8855 274X, GRID grid.416695.9, Department of Gastroenterology, , Saitama Cancer Center, ; Saitama, Japan
                [4 ]GRID grid.415479.a, Department of Endoscopy, , Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, ; Tokyo, Japan
                [5 ]ISNI 0000 0004 1936 9959, GRID grid.26091.3c, Center for Diagnostic and Therapeutic Endoscopy, , Keio University, ; Tokyo, Japan
                [6 ]ISNI 0000 0004 1793 0765, GRID grid.416963.f, Department of Gastrointestinal Oncology, , Osaka Medical Center for Cancer and Cardiovascular Diseases, ; Osaka, Japan
                [7 ]GRID grid.415495.8, Department of Gastroenterology, , Sendai City Medical Center, ; Miyagi, Japan
                [8 ]ISNI 0000 0004 0639 8670, GRID grid.412181.f, Department of Gastroenterology, , Niigata University Medical and Dental Hospital, ; Niigata, Japan
                [9 ]ISNI 0000 0000 8962 7491, GRID grid.416751.0, Department of Gastroenterology, , Saku Central Hospital Advanced Care Center, ; Nagano, Japan
                [10 ]ISNI 0000 0001 0661 2073, GRID grid.411898.d, Department of Endoscopy, , The Jikei University School of Medicine, ; 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461 Japan
                Article
                527
                10.1007/s10388-016-0527-7
                5362661
                28386209
                83e98c2a-a2e9-4dd5-83d6-357529728e89
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 26 August 2015
                : 9 February 2016
                Categories
                Special Article
                Custom metadata
                © The Japan Esophageal Society and Springer Japan 2017

                Otolaryngology
                magnifying endoscopy,esophageal cancer,squamous cell carcinoma,invasion depth,japan esophageal society classification

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