ABSTRACT
A 62-year-old man with a flat early esophageal cancer was referred for endoscopic treatment. White light imaging revealed a pale red lesion, whereas linked color imaging (LCI) and blue laser imaging (BLI) yielded purple and brown images, respectively. Iodine staining demonstrated a large unstained area with a homogenous but very weak pink-color sign. This area appeared more clearly as purple and green on LCI and BLI, respectively; however, a different colored portion was observed at the 4 o'clock position inside the iodine-unstained area. Histopathology findings of the resected specimen revealed squamous intraepithelial neoplasia at the 4 o'clock position and an esophageal squamous cell carcinoma in the remaining iodine-unstained area. LCI and BLI combined with iodine staining produce characteristic images that overcomes the pink-color sign, reflecting the histological features of a flat esophageal neoplasm. This new method is useful for detailed evaluation of early flat squamous cell neoplasms.
Subject(s)
Humans , Middle Aged , Carcinoma, Squamous Cell , Epithelial Cells , Esophageal Neoplasms , Iodine , Methods , Neoplasms, Squamous CellABSTRACT
Objective To explore the diagnostic value of pink sign of iodine staining for early esophageal carcinoma. Methods Data of 312 lesions of 306 patients with suspected early esophageal carcinoma who received iodine staining from November 2015 to October 2017 were analyzed retrospectively. Lesions were divided into positive pink sign group and negative pink sign group according to the result of iodine staining. The relationship between pink sign and pathology were analyzed. Lesions recorded onset time of pink sign were divided into 4 groups by the onset time of pink sign, 0-30 s,>30-60 s,>60-90 s and>90-120 s, the diagnostic value of which was assessed with the receiver operating characteristic ( ROC) curve. Results Among the 312 lesions, 208 were identified positive pink sign, including 28 of inflammation or low-grade intraepithelial neoplasia ( LGIN ) , 180 of high-grade intraepithelial neoplasia ( HGIN ) or carcinoma, and 104 lesions were identified negative pink sign, including 69 of inflammation or LGIN, 35 of HGIN or carcinoma. The sensitivity, specificity and accuracy of positive pink sign in the diagnosis of HGIN and early esophageal carcinoma was 83. 7％, 71. 1％ and 79. 8％, respectively. Multivariate analysis showed a significant association between the onset time of pink sign and histopathology ( P=0. 000, OR=0. 016, 95％CI=0. 042-0. 324) . The onset time of pink sign was recorded in 89 lesions in the positive group. The area under ROC curve of the onset time of pink sign was 0. 899, and the optimal cut-off value was 60 s, which indicated the good validity of the test with the sensitivity, specificity and accuracy of 92. 8％, 84. 2％and 91. 0％, respectively. Conclusion The pink sign of iodine staining for diagnosis of early esophageal carcinoma shows a high consistance rate, especially that appears within 60 s.
ABSTRACT
Objective To systematically evaluate the value of narrow band imaging(NBI)and iodine staining in early diagnosis of esophageal cancer and precancerous lesions.Methods The databases of PubMed,Embase,CNKI,VIP technological journals and Wanfang digital journals were retrieved by computer for searching the literatures on the value of NBI and iodine staining in diagnosing early esophageal cancer and precancerous lesions.The Meta-Disc 1.4 software was used to conduct the meta analysis and calculate the pooled sensitivity,specificity and 95％ confidence interval(95％ CI).Summary receiver operating characteristic(SROC)curve was drawn and the area under curve(AUC)was calculated,thus the diagnostic values of the two methods were evaluated.Results Totally 13 articles were included,including 975 patients.The pooled sensitivity and specificity for NBI were 0.88(95％CI=0.86 to 0.90)and 0.79(95％CI=0.76 to 0.82).The pooled sensitivity and specificity for iodine staining were 0.95(95％CI=0.93 to 0.97)and 0.45(95％CI=0.40 to 0.49).AUC of SROC for the two methods were 0.938 6 and 0.952 9 respectively.There was no statistically difference in the AUC values between the two methods(Z=0.519,P>0.05).Conclusion NBI and iodine staining are both effective ways in the diagnosis of early esophageal cancer and precancerous lesions.And both of them have a certain clinical value.
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Objective To explore the feasibility of Lugol's iodine staining in association with P53 oncoprotein test to detect early esophageal cancer and precancerous lesions through endoscopy. Methods Lugol's iodine was sprayed on esophageal mucosa under endoscopy in 78 patients with suspected early malignancy. Severe dysplasia which taken from unstained position by iodine were prepared immunohistochemically for P53 oncoprotein study. Then endoscopic mucosal resection (EMR) was performed to these severe dysplasia with P53 oncoprotein－ positive mucosa. Results There were 31 unstained areas (25 patients) including squamous cell carcinomas (n=3) and severe dysplasias (n=16). Expression of P53 was found in 7 severe dysplasia (43.8％ ),and 1 carcinoma in situ was found by EMR. Conclusion This modified method seemed feasible not only to detect early esophageal cancer,but also to resect severe dysplasia mucosa selectively by EMR.
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Objective To evaluate the application and effect of endoscopic screening directly with i-odine stain in high risked area of esophageal cancer and compare the detecting rate of cancer and dysplasia before and after iodine stains. Methods In the high risked area of esophageal cancer, endoscopic exam were directly performed in 3 022 people, aged 40 - 69 years with iodine staining and biopsy, then observing and recording the alternation of color and morphology of mucbsa and texture of submucosal blood vessels before and after iodine staining. Results One hundred and thirty one cases of esophageal carcinoma and 659 cases of moderate and severe dysplasia were diagnosed by biopsy; the discovery of esophageal cancer before and after iodine stain were 57 ( 1. 9% ) and 111(3.7%) cases, while of moderate and severe dysplasia were 154(5. 0% ) and 659(21. 8% ) cases respectively with significant statistical differences. Conclusion The mucosal iodine staining under endoscopy markedly increased the detecting rates of early superficial esophageal cancer and dysplasia ( moderate and severe) .