Bimodal Chromoendoscopy with Confocal Laser Endomicroscopy for the Detection of Early Esophageal Squamous Cell Neoplasms

BACKGROUND/AIMS: This study aimed to evaluate the diagnostic accuracy of dual-focus narrow-band imaging (dNBI) and Lugol'schromoendoscopy (LCE) combined with probe-based confocal laser endomicroscopy (pCLE) to screen for esophageal squamous cell neoplasms (ESCNs) in patients with a history of head and neck cancer. METHODS: From March to August 2016, dNBI was performed. Next, LCE was performed, followed by pCLE and biopsy. Histology has historically been the gold standard to diagnose ESCN. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI and LCE adjunct with pCLE were determined. RESULTS: Twenty-four patients were included. Ten ESCNs were found in 8 patients (33%). Forty percent of high-graded intraepithelial neoplasias and all low-grade intraepithelial neoplasias were overlooked by dNBI. The sensitivity, specificity, PPV, NPV, and accuracy of dNBI vs. LCE combined with pCLE were 50% vs. 80%, 62% vs. 67%, 36% vs. 44%, 75% vs. 91%, and 83% vs. 70%, respectively. CONCLUSIONS: The use of dNBI to detect ESCN was suboptimal. LCE with pCLE following dNBI had additional value for detecting esophageal dysplasia not detected by dNBI. The use of pCLE to detect dNBI-missed lesions yielded a high NPV, while pCLE-guided biopsy could reduce the number of unnecessary biopsies.

Preoperative Iodine Staining May Complicate the Demarcation of Esophageal Carcinoma

A 53-year-old man was suspected of having an esophageal neoplasm. An endoscopic examination including Lugol chromoendoscopy suggested an esophageal squamous cell neoplasm limited to the lamina propria. A targeted biopsy showed atypical squamous cells, and an endoscopic submucosal dissection was performed 22 days after the previous endoscopy. Although a single 40 mm unstained area was observed by preoperative Lugol chromoendoscopy, intraoperative endoscopy revealed a 25 mm iodine-unstained area, with small unstained areas scattered on the oral side. We included the small unstained areas in the extent of the resection through assessment by preoperative endoscopy. Histopathologically, the tumor extent appeared to coincide with the preoperative assessment. Tumor cells were found in the basal-parabasal layers of the mucosa, in which small unstained areas were scattered, although the superficial layers exhibited well-differentiated cells containing glycogen in the cytoplasm. Although Lugol chromoendoscopy, which can induce chemical esophagitis, is widely used, re-epithelialization after mucosal damage by preoperative iodine staining may complicate the intraoperative demarcation of tumors.

The Significance of Connexin 26 Expression in Squamous Cell Lesions of the Larynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Gap junctional intercellular communication (GJIC) is a mechanism for direct cell to cell signalling and is mediated by gap junctions, which consist of transmembrane proteins called connexins (Cxs). The authors investigated the role of connexin 26 as a biomarker that helps diagnose laryngeal squamous cell lesions. SUBJECTS AND METHOD: Paraffin-embedded tissue specimens from 50 patients, who were diagnosed with laryngeal invasive squamous cell carcinoma (n=15), carcinoma in situ (n=10), dysplasia (n=15), and non-neoplastic epithelial hyperplasia (n=10) between 1993 and 2005, were immunohistochemically stained for connexin 26 protein. RESULTS: Intracytoplasmic positive expression of connexin 26 was found in 100% of invasive squamous cell carcinoma and in 20% of carcinoma in situ. However, in dysplasia and hyperplasia, there were no positive expressions. Moreover, the majority of intercellular or membranous staining tended to decline in dysplasia, carcinoma in situ, and squamous cell carcinoma. CONCLUSION: These results suggest that aberrant expression of connexin 26 in laryngeal squamous cell lesions can be associated with tumorigenesis and invasion. Further studies are needed to investigate these expressions of connexin 26 and that it may represent more aggressive pathology of the larynx.