Division of Gastroenterology and Hepatology, Department of Medicine I, Cantonal Hospital, St. Gallen 9007, Switzerland.
Surg Endosc. 2009 Dec;23(12):2748-54. doi: 10.1007/s00464-009-0489-0. Epub 2009 May 15.
Patients with achalasia or malignancies of the head and neck are at increased risk for esophageal squamous cell carcinoma. The discussion of a screening and surveillance program is controversial. The aim of the present study was to determine the diagnostic potential of Lugol chromoendoscopy combined with brush cytology to diagnose esophageal squamous cell carcinoma and high-grade dysplasia. Secondly, the benefit of additional biomarkers was investigated.
A total of 61 patients (21 patients with achalasia and 40 patients with malignancies of the head and neck) were included. Chromoendoscopy with 1.2% Lugol iodine solution with targeted biopsies and brush cytology processed by digital image cytometry (DICM) and fluorescence in situ hybridization (FISH) from unstained lesions (USLs) and stained mucosa were performed.
Six of the 61 patients had USLs ≥2 cm. Four patients had high-grade dysplasia (HGD) or carcinoma in situ (CIS). One patient with HGD and one patient with CIS were detected only after Lugol chromoendoscopy. The sensitivity and specificity for detected HGD or CIS in USLs ≥2 cm were 100% and 96.5%. No dysplasia was found in USLs <2 cm. DNA ploidy by DNA cytometry and p53 loss of heterozygosity (LOH) by fluorescence in situ hybridization showed no additional impact on diagnostic accuracy.
Lugol chromoendoscopy enhances the detection rate of high-risk lesions with dysplasia or carcinoma in situ in large unstained lesions. Biomarkers such as aneuploidy and p53 LOH from brush cytology were not of additional benefit in this setting.
贲门失弛缓症或头颈部恶性肿瘤患者患食管鳞状细胞癌的风险增加。关于筛查和监测计划的讨论存在争议。本研究旨在确定卢戈氏染色内镜联合刷检细胞学诊断食管鳞状细胞癌和高级别上皮内瘤变的诊断潜力。其次，研究了额外生物标志物的获益。
共纳入 61 例患者（21 例贲门失弛缓症患者和 40 例头颈部恶性肿瘤患者）。对 61 例患者进行卢戈氏染色内镜检查，对直径≥2cm 的无染色病变（USLs）及染色黏膜进行 1.2%卢戈氏碘溶液染色，并进行靶向活检和刷检，由数字图像细胞学（DICM）和荧光原位杂交（FISH）分析刷检细胞学。
61 例患者中有 6 例 USLs 直径≥2cm。4 例患者存在高级别上皮内瘤变（HGD）或原位癌（CIS）。1 例 HGD 和 1 例 CIS 仅在卢戈氏染色内镜检查后发现。USLs 直径≥2cm 时，检测 HGD 或 CIS 的敏感性和特异性分别为 100%和 96.5%。USLs 直径<2cm 时未发现上皮内瘤变。DNA 倍体分析和荧光原位杂交检测 p53 杂合性丢失（LOH）对诊断准确性无额外影响。
卢戈氏染色内镜可提高对大无染色病变中伴异型增生或原位癌的高危病变的检出率。在这种情况下，刷检细胞学的非整倍体和 p53 LOH 等生物标志物无额外获益。
