Dawsey S M, Fleischer D E, Wang G Q, Zhou B, Kidwell J A, Lu N, Lewin K J, Roth M J, Tio T L, Taylor P R
Cancer Prevention Studies Branch, National Cancer Institute, Bethesda, Maryland 20892-7058, USA.
Cancer. 1998 Jul 15;83(2):220-31.
In previous studies in the high risk population of Linxian, China, the majority of foci of high grade (moderate and severe) squamous dysplasia (HGD) and invasive squamous carcinoma (CA) of the esophagus were associated with endoscopically visible lesions that could be targeted for biopsy, but some foci of HGD were missed by routine endoscopic examination. This study examined whether spraying the mucosa with Lugol's iodine solution, which stains normal epithelium brown but leaves dysplasia and carcinoma unstained, could improve endoscopic detection and delineation of these lesions.
Two hundred twenty-five Linxian adults with balloon cytologic evidence of dysplasia or carcinoma underwent endoscopy. All visible lesions were described and photographed before and after staining with 1.2% Lugol's iodine solution. Biopsies were taken from all lesions visible before staining, from all unstained lesions (USLs) after applying the stain, and from representative control areas of stained mucosa.
Two hundred fifty-three USLs and 255 control sites were biopsied. No complications occurred. Ninety-four biopsy sites contained HGD and 20 contained CA. Before staining, the sensitivity of visible lesions for identifying HGD or CA was 62%, and the specificity was 79%. After staining, the sensitivity of USLs for identifying HGD or CA was 96%, and the specificity was 63%. Eighty-eight percent of the HGD and CA lesions were larger or more clearly defined after staining. The diagnostic lesions in 17 of 31 patients with moderate dysplasia (55%), 8 of 35 patients with severe dysplasia (23%), and none of the 19 patients with invasive carcinoma (0%) were identified only after staining.
Mucosal iodine staining improved endoscopic detection and delineation of HGD and CA in these patients. This simple technique is highly sensitive for identifying these precursor and invasive squamous lesions, and it should be used whenever optimal visualization of squamous mucosal abnormalities is required.
在中国林县的高危人群此前的研究中，大多数食管高级别（中度和重度）鳞状上皮发育异常（HGD）病灶和浸润性鳞状细胞癌（CA）与内镜下可见的、可靶向活检的病变相关，但一些HGD病灶在常规内镜检查中被漏诊。本研究探讨了用卢戈氏碘液喷洒黏膜（正常上皮被染成棕色，但发育异常和癌组织不着色）是否能改善这些病变的内镜检测及轮廓显示。
225名有发育异常或癌的气球细胞学证据的林县成年人接受了内镜检查。所有可见病变在用1.2%卢戈氏碘液染色前后均进行描述和拍照。对染色前所有可见病变、染色后所有未染色病变（USLs）以及染色黏膜的代表性对照区域进行活检。
对253个USLs和255个对照部位进行了活检。未发生并发症。94个活检部位含有HGD，20个含有CA。染色前，可见病变识别HGD或CA的敏感性为62%，特异性为79%。染色后，USLs识别HGD或CA的敏感性为96%，特异性为63%。88%的HGD和CA病变在染色后更大或边界更清晰。31例中度发育异常患者中有17例（55%）、35例重度发育异常患者中有8例（23%）以及19例浸润性癌患者中无一例（0%）的诊断性病变仅在染色后才被识别。
黏膜碘染色改善了这些患者中HGD和CA的内镜检测及轮廓显示。这种简单技术在识别这些前驱性和浸润性鳞状病变方面高度敏感，每当需要最佳显示鳞状黏膜异常时均应使用。
