Clin Endosc.  2019 Sep;52(5):497-501. 10.5946/ce.2018.195.

New Diagnostic Approach for Esophageal Squamous Cell Neoplasms Using Linked Color Imaging and Blue Laser Imaging Combined with Iodine Staining

• Tsunoda M
• Miura Y
• Osawa H
• Khurelbaatar T
• Sakaguchi
• Fukuda H
• Lefor AK
• Yamamoto H

• KMID: 2464672
• DOI: http://doi.org/10.5946/ce.2018.195

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.

Keyword

Early esophageal cancer; Image enhanced endoscopy; Linked color imaging; Blue laser imaging; Iodine staining

MeSH Terms

Carcinoma, Squamous Cell
Epithelial Cells*
Esophageal Neoplasms
Humans
Iodine*
Methods
Middle Aged
Neoplasms, Squamous Cell*
Iodine

Figure

• 

  Fig. 1. Endoscopic images of esophageal squamous cell neoplasm. (A-C) Before iodine staining. (A) White light imaging shows slightly red lesion from the 3 to 5 o’clock position. (B) Linked color imaging shows a purple lesion. (C) Blue laser imaging shows a brown lesion. (D-F) Three minutes 35 seconds after iodine staining. (D) The entire lesion has a positive pink-color sign on white light imaging. (E) Linked color imaging shows a purple area in most of the main lesion but pale yellow mucosa at the 4 o’clock position (light blue arrow). (F) Blue laser imaging shows a green lesion in most of the main lesion but there is brown mucosa at the 4 o’clock position (light blue arrow).

• 

  Fig. 2. Histological features of the resected specimen. (A, B) Endoscopically resected specimen—Red line indicates the area with different colors on linked color imaging and blue laser imaging. (C) Histopathological findings of the lesion indicated by the red line on image A and B (hematoxylin & eosin, ×2.57). (D) A magnified image shows the histopathological findings at the border between squamous cell carcinoma (left half) and intraepithelial neoplasia (right half) (hematoxylin & eosin, ×8.17). (E) The magnified image shows the histopathological findings at the border between intraepithelial neoplasia (left half) and normal mucosa (right half) (hematoxylin & eosin, ×8.17).

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