Clinicopathological features of narrow-band imaging endoscopy and immunohistochemistry in ultraminute esophageal squamous neoplasms

Use of Immunohistochemical p53 Mutant-Phenotype in Diagnosis of High-Grade Dysplasia of Esophageal Squamous Epithelia

BACKGROUND

Mild cellular atypia of esophageal squamous epithelial dysplasia has a risk of progressing to cancer that poses great confusion for pathological diagnosis. There is no research on the diagnosis and differential diagnosis of esophageal squamous dysplasia by the expression of immunohistochemical (IHC) p53. The study aims to conduct a graded diagnosis of esophageal squamous epithelial hyperplasia by combining p53 expressions and microscopic histomorphological characteristics.

METHODS

The study was conducted from January 2021 to January 2022 and included a total of 208 cases including 262 specimens with atypical hyperplasia or dysplasia of squamous epithelia discovered by esophageal mucosal biopsy. HE staining was used to grade the epithelial hyperplasia degree, and all cases underwent p53 IHC evaluation.

RESULTS

Benign lesions: we did not find any p53 IHC mutant-phenotype (0/12 cases) in 12 cases of esophagitis. We found 10 cases (10/80 cases) of p53 IHC mutant-phenotype in 80 cases of low-grade dysplasia, and 158 cases (158/170 cases) of p53 IHC mutant-phenotype of high-grade lesions in 170 cases of high-grade dysplasia and early cancer based on the χ2 test results. We found statistically significant differences in p53 IHC mutant-phenotype between the high-grade squamous epithelial lesions and benign lesions. The sensitivity and specificity of p53 in detecting high-grade squamous epithelial lesions were 92.9% and 89.1%, respectively. The positive predictive value was 94.0%, and the negative predictive value was 87.2%.

CONCLUSION

In this study, we found that p53 IHC had high sensitivity and specificity in detecting high-grade esophageal squamous epithelial lesions. Therefore, it has potential to be used as a routine item in pathological detection for auxiliary risk stratification of esophageal squamous epithelial lesions.

Efficacy of narrow-band imaging in detecting early esophageal cancer and risk factors for its occurrence

OBJECTIVE

The aim of this study is to evaluate the efficacy of narrow-band imaging (NBI) in the detecting early esophageal cancer and precancerous lesions and to investigate the risk factors for its occurrence.

METHODS

The esophagus was examined with ordinary endoscopy, NBI, and iodine staining. All the lesions were confirmed by histopathologically as the gold standard; NBI and intrapapillary capillary scale (IPCL) scale were compared with pathologic diagnosis. The accuracy, sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated. Subgroup analysis was performed between the elderly vs. younger group, and head and neck squamous cell cancer (HNSCC) vs. non-HNSCC patients.

RESULTS

Ninety lesions were detected with ordinary endoscopy, 108 with NBI, and 120 with iodine staining. All esophageal cancers were detected both by NBI and by iodine staining. Accuracy, sensitivity, and specificity for esophageal cancer and precancerous lesion were 67.8%, 58.1%, and 76.6%; 92%, 89.7%, and 96%; 93.4%, 93.4%, and 93.2%, respectively. NBI endoscopy and iodine staining were superior to ordinary endoscopy for detecting esophageal cancer and precancerous lesions (p < 0.05). NBI showed better detection of esophageal neoplasms in the elderly patients (p < 0.001). The incidence of multiple squamous cell cancers (SCCs) was significantly higher in non-elderly group (p = 0.009). NBI can also detect more esophageal neoplastic lesions in patients with head and neck cancers (p = 0.003).

CONCLUSIONS

NBI endoscopy appears as effective as Lugol staining to detect and screen the early esophageal cancer. NBI shows better detection of esophageal neoplasms in the elderly patients. The incidence of multiple SCCs was much higher in non-elderly patients.

Clinicopathologic characteristics and management of minute esophageal lesions diagnosed by narrow-band imaging endoscopy

BACKGROUND AND STUDY AIMS

Magnifying narrow-band imaging (NBI) endoscopy enables the diagnosis of minute esophageal neoplasia. We aimed to evaluate clinicopathological diagnosis of minute esophageal neoplasia by using magnifying NBI endoscopy and biopsy.

PATIENTS AND METHODS

In total, 309 patients (127 men and 182 women) with minute esophageal lesions of intrapapillary capillary loop (IPCL) type IV were enrolled. Of these patients, 249 underwent biopsy for histologic diagnosis and also for treatment. Of the 249 patients, 123 underwent follow-up with endoscopy. We analyzed the clinicopathologic characteristics and prognosis of these lesions after biopsy.

RESULTS

Of the 249 biopsied lesions, we histologically diagnosed 11 as high-grade intraepithelial neoplasia (HGIN), 41 as low-grade intraepithelial neoplasia (LGIN), and 197 as non-neoplasia (Non-N) including inflammation. Six of the 11 HGINs and 11 of the 41 LGINs showed slight elevation. Background coloration was observed in 9 of 11 HGINs, 34 of 41 LGINs, and 33 of 197 Non-Ns. Of the 249 biopsied lesions, 147 were microscopically measurable. The average diameter was 1.4 mm for HGINs and 0.8 mm for LGINs. Of the 123 patients who underwent post-biopsy follow-up, 93 (76 %) showed no lesions at the biopsied sites during the NBI examinations and were suspected to have undergone complete resection by biopsy.

CONCLUSIONS

Biopsy was useful for diagnosis and treatment of minute esophageal lesions, diagnosed as IPCL type IV by magnifying NBI endoscopy.

Peroral endoscopic myotomy: an evolving treatment for achalasia

Peroral endoscopic myotomy (POEM) was first performed in Japan in 2008 for uncomplicated achalasia. With excellent results, it was adopted by highly skilled endoscopists around the world and the indications for POEM were expanded to include advanced sigmoid achalasia, failed surgical myotomy, patients with previous endoscopic treatments and even other spastic oesophageal motility disorders. With increased uptake and performance of POEM, variations in technique and improved management of adverse events have been developed. Now, 6 years since the first case and with >3,000 procedures performed worldwide, long-term data has shown the efficacy of POEM to be long-lasting. A growing body of literature also exists pertaining to the learning curve, application of novel technologies, extended indications and physiologic changes with POEM. Ultimately, this once experimental procedure is evolving towards becoming the preferred treatment for achalasia and other spastic oesophageal motility disorders.