Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Dis Esophagus. 2014 Apr;27(3):267-75. doi: 10.1111/dote.12090. Epub 2013 Jun 24.
To reveal clinicopathological features of narrow-band imaging (NBI) endoscopy and immunohistochemistry in ultraminute esophageal squamous neoplasms. If a lesion diameter was smaller or same compared with a width of closed biopsy forceps, a lesion was defined to be an ultraminute lesion. Twenty-five consecutive patients with 33 ultraminute esophageal lesions that were removed by endoscopic mucosal resection were included in the present study. We conducted two questionnaire surveys of six endoscopists by their retrospective review of endoscopic still images. The six endoscopists evaluated the endoscopic findings of the ultraminute lesions on still images taken by conventional white-light imaging endoscopy and non-magnified NBI endoscopy in the first questionnaire, and taken by magnified NBI endoscopy in the second questionnaire. An experienced pathologist who was unaware of any endoscopic findings made histological diagnosis and evaluated immunoexpression of p53 and Ki67. The 33 ultraminute lesions were all determined to be either 11 high-grade intraepithelial neoplasias (HGIENs) or 22 low-grade intraepithelial neoplasias (LGIENs). The tumor diameters were histologically confirmed to be <3 mm. All of the ultraminute tumors were visualized as unstained areas and brownish areas by real-time endoscopy with Lugol dye staining and non-magnified NBI endoscopy, respectively. All of the ultraminute IENs were visualized as brownish areas by real-time non-magnified NBI endoscopy. Three of the 25 patients with the ultraminute IENs (12%) had multiple brownish areas (more than several areas) in the esophagus on real-time non-magnified NBI endoscopy. All of the ultraminute IENs were visualized as unstained areas by real-time Lugol chromoendoscopy. Twenty of the 25 patients (80%) had multiple unstained areas (more than several areas) in the esophagus on real-time Lugol chromoendoscopy. The first questionnaire survey revealed that a significantly higher detection rate of the ultraminute IENs on non-magnified NBI endoscopy images compared with conventional white-light imaging endoscopy ones (100% vs. 72%, respectively: P < 0.0001). The second questionnaire survey revealed that presence rates of any magnified NBI endoscopy findings were not significantly different between HGIENs and LGIENs. Proliferation, dilation, and various shapes of intrapapillary capillary loops indicated remarkably high presence rates of more than 90% in both HGIENs and LGIENs. Six of 22 LGIENs (27%) and 3 of 11 HGIENs (27%) show a positive expression for p53. None of peri-IEN epithelia was positive for p53. A mean of Ki67 labeling index of LGIENs was 33% and that of HGIENs 36%. Ki67 labeling index was significantly greater in the LGIENs and HGIENs compared with that in the peri-IEN epithelia. There were no significant differences in p53 expression and Ki67 labeling index between the HGIENs and LGIENs. Non-magnified/magnified NBI endoscopy could facilitate visualization and characterization of ultraminute esophageal squamous IENs. The ultraminute HGIENs and LGIENs might have comparable features of magnified NBI endoscopy and immunohistochemistry.
为了揭示窄带成像（NBI）内镜和免疫组织化学在超微食管鳞状上皮内肿瘤中的临床病理特征。如果病变直径与闭合活检钳的宽度相同或更小，则定义为超微病变。本研究纳入了 25 例连续患者的 33 个超微食管病变，这些病变均通过内镜黏膜切除术切除。我们对 6 名内镜医生进行了两次问卷调查，让他们回顾性地查看常规白光成像内镜和非放大 NBI 内镜拍摄的内镜静止图像。在第一次问卷调查中，6 名内镜医生评估了超微病变的内镜表现，在第二次问卷调查中，他们评估了放大 NBI 内镜拍摄的超微病变的内镜表现。一位不了解任何内镜发现的经验丰富的病理学家进行了组织学诊断，并评估了 p53 和 Ki67 的免疫表达。33 个超微病变均被确定为 11 个高级别上皮内瘤变（HGIENs）或 22 个低级别上皮内瘤变（LGIENs）。肿瘤直径经组织学证实均<3mm。所有的超微肿瘤在实时内镜下经卢戈氏碘染色和非放大 NBI 内镜检查，分别显示为无染色区和棕褐色区。所有的超微 IENs 在实时非放大 NBI 内镜下均显示为棕褐色区。25 例超微 IEN 患者中有 3 例（12%）在实时非放大 NBI 内镜下食管内有多个棕褐色区（多个区域）。所有的超微 IENs 在实时卢戈氏染色内镜下均显示为无染色区。25 例患者中有 20 例（80%）在实时卢戈氏染色内镜下食管内有多个无染色区（多个区域）。第一次问卷调查显示，非放大 NBI 内镜图像对超微 IEN 的检出率明显高于常规白光成像内镜（100%比 72%：P<0.0001）。第二次问卷调查显示，HGIENs 和 LGIENs 的任何放大 NBI 内镜表现的存在率均无显著差异。增殖、扩张和各种形状的黏膜内毛细血管袢的存在率均在 90%以上，在 HGIENs 和 LGIENs 中均有显著表现。22 个 LGIENs 中有 6 个（27%）和 11 个 HGIENs 中有 3 个（27%）的 p53 表达呈阳性。无 peri-IEN 上皮 p53 阳性。LGIENs 的 Ki67 标记指数平均为 33%，HGIENs 的 Ki67 标记指数为 36%。LGIENs 和 HGIENs 的 Ki67 标记指数明显高于 peri-IEN 上皮。HGIENs 和 LGIENs 的 p53 表达和 Ki67 标记指数无显著差异。非放大/放大 NBI 内镜有助于可视化和特征化超微食管鳞状上皮内肿瘤。超微 HGIENs 和 LGIENs 可能具有相似的放大 NBI 内镜和免疫组织化学特征。
