Swangsri Jirawat, Nakajima Yasuaki, Kawada Kenro, Tokairin Yutaka, Suzuki Tomoyoshi, Miyawaki Yutaka, Hoshino Akihiro, Okada Takuya, Ota Shunsuke, Ryotokuji Tairo, Fujiwara Naoto, Nishikage Tetsuro, Nagai Kagami, Kawachi Hiroshi, Kawano Tatsuyuki
Department of Esophageal and General Surgery, Tokyo Medical and Dental University.
J Med Dent Sci. 2014 Jan 17;60(4):83-91.
To identify the clinical T stage by endoscopy is a major diagnostic goal for superficial esophageal squamous cell carcinoma (ESCC). The completion of a microvascular morphological study of mucosal lesions is necessary to optimize therapy.
Images of 197 intra-papillary capillary loops (IPCLs) captured by magnified endoscopy from 15 esophagectomy specimens were studied for their morphological features and IPCL dimensions.
The microvascular morphology was classified into four basic major patterns: 1. spiral loop, 2. wide loop (WL), 3. globular (G) and 4. reticular pattern. The microvascular features and dimensions differed according to the depth of tumor invasion. Especially the mean bundle outline (IPCL diameter) showed significant changes as 20.02, 22.32, and 27.08 μm, respectively, for M1, M2 and M3, respectively (M1:M2 P < 0.05, M2:M3 P < 0.01).
During tumor stage progression, a high-volume blood demand and cancer cell overgrowth to occupy the laminar propria mucosa (LPM) cause obvious elongation, thickening, branching, irregularity and deformity of the IPCL, which were characteristics of M3 lesions. The results of the present study support and can be applied with the current Japanese classification for improving the diagnostic accuracy, especially to differentiate between M2 and M3 lesions based on the endoscopic findings.
