Magnifying Chromoendoscopy of the Esophagus: In-Vivo Pathological Diagnosis Using an Endocytoscopy System

Background and Study Aims: The aim of the present study was to observe the endoscopic characteristics of cells on the surface layer of superficial esophageal carcinomas in vivo using an endocytoscopy system and to compare the findings with those in normal squamous epithelium.
Patients and Methods: Superficial esophageal cancers in 12 patients were examined with methylene blue staining using an endocytoscopy system.
Results: The endocytoscopy system and methylene blue staining made it possible to observe cells on the surface of the squamous epithelium in normal esophageal mucosa. Normal cells were arranged homogeneously, and the nucleus cytoplasm ratio was uniform and low. In esophageal cancers, the density of cells was found to be much greater than that in normal squamous epithelium. The cell distribution was also irregular and the cells were extremely heterogeneous, with the nuclei having different staining, size, and shape characteristics. The nucleus cytoplasm ratio was also very irregular.
Conclusions: Examining esophageal tissue using the endocytoscopy system described here makes it possible to observe detailed histological alterations in esophageal lesions in vivo.

References

• 1 Hamou J E. Microendoscopy and contact endoscopy. Brevet Français 79; 04 168 (Paris, 1979); International Patent PCT/FR80/0024 (Paris, 1980); US Patent 4,385,810 (Washington, DC, 1983). 
• 2 Andrea M, Dias O, Santos A. Contact endoscopy during microlaryngeal surgery: a new technique for endoscopic examination of the larynx.  Ann Otol Rhinol Laryngol. 1995;  104 333-339
• 3 Andrea M, Dias O, Santos A. Contact endoscopy of the vocal cord: normal and pathological patterns.  Acta Otolaryngol. 1995;  115 314-316
• 4 Pak M W, To K F, Leung S F, van Hasselt C A. In vivo diagnosis of persistent and recurrent nasopharyngeal carcinoma by contact endoscopy.  Laryngoscope. 2002;  112 1459-1466
• 5 Pak M W, To K F, Leung S F, van Hasselt C A. In vivo diagnosis of nasopharyngeal carcinoma using contact rhinoscopy.  Laryngoscope. 2001;  111 1453-1458
• 6 Inoue H, Cho J Y, Satodate H. et al . Development of virtual histology and virtual biopsy using laser-scanning confocal microscopy.  Scand J Gastroenterol Suppl. 2003;  237 37-39
• 7 Kumagai Y, Inoue H, Nagai K. et al . Magnifying endoscopy, stereoscopic microscopy and the microvascular architecture of superficial esophageal carcinoma.  Endoscopy. 2002;  34 369-375
• 8 Inoue H, Honda T, Nagai K. et al . Ultra-high magnification endoscopic observation of carcinoma in situ.  Dig Endosc. 1997;  1 16-18
• 9 Inoue H, Honda T, Yoshida T. et al . Ultra-high magnification endoscopy of the normal esophageal mucosa.  Dig Endosc. 1996;  2 134-138
• 10 Endo M, Takeshita K, Yoshida M. How can we diagnose the early stage of esophageal cancer? Endoscopic diagnosis.  Endoscopy. 1986;  18 (Suppl 3) 11-18
• 11 Liu H H, Yoshida M, Momma K. et al . Detection and treatment of an asymptomatic case of early esophageal cancer using chromoendoscopy and endoscopic mucosal resection.  J Formos Med Assoc. 2002;  101 219-222
• 12 Kiesslich R, von Bergh M, Hahn M. et al . Chromoendoscopy with indigo carmine improves the detection of adenomatous and nonadenomatous lesions in the colon.  Endoscopy. 2001;  33 1001-1006
• 13 Okabayashi T, Gotoda T, Kondo H. et al . Usefulness of indigo carmine chromoendoscopy and endoscopic clipping for accurate preoperative assessment of proximal gastric cancer.  Endoscopy. 2000;  32 S62
• 14 Canto M I, Setrakian S, Willis J. et al . Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett’s esophagus.  Gastrointest Endosc. 2000;  51 560-568
• 15 Canto M I. Methylene blue chromoendoscopy for Barrett’s esophagus: coming soon to your GI unit?.  Gastrointest Endosc. 2001;  54 403-409
• 16 Herlin P, Marnay J, Jacob J H. et al . A study of the mechanism of the toluidine blue dye test.  Endoscopy. 1983;  15 4-7
• 17 Dutt M K. Basic dyes in the staining of DNA-phosphate groups and DNA-aldehyde molecules in cell nuclei.  Microsc Acta. 1982;  85 361-368
• 18 Fleischer D E. Chromoendoscopy and magnification endoscopy in the colon.  Gastrointest Endosc. 1999;  49 S45-S49
• 19 Canto M I, Setrakian S, Willis J. et al . Methylene blue-directed biopsies improve detection of intestinal metaplasia and dysplasia in Barrett’s esophagus.  Gastrointest Endosc. 2000;  51 560-568
• 20 Kumagai Y, Toi M, Inoue H. Dynamism of tumour vasculature in the early phase of cancer progression: outcomes from oesophageal cancer research.  Lancet Oncol. 2002;  3 604-610