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DOI: 10.1055/s-2004-826095
Diagnosis of Esophagogastric Tumors
Publikationsverlauf
Publikationsdatum:
19. Januar 2005 (online)
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With regard to esophageal tumors, important reports on several topics have been published recently. 1) The place of endoscopic ultrasonography (EUS) as the best locoregional staging technique for cancer of the esophagus has been further consolidated. The addition of fine-needle aspiration makes EUS more sensitive than computed tomography (CT) and more accurate than CT or EUS alone for nodal staging. 2) High-resolution endoscopy with chromoendoscopy has been found to be very effective for mucosal lesions, but not for submucosal lesions. In combination with EUS, the sensitivity for submucosal tumors increases up to 60 %. 3) Autofluorescence-guided biopsy has been reported to be a good tool for detecting high-grade dysplasia. A narrow-band imaging system improved the overall accuracy for depth of invasion. 4) The incidence of hypopharyngeal cancer increases after resection for esophageal carcinoma. Patients with a scattered staining pattern after application of Lugol’s solution are more prone to develop upper lesions. 5) Fluorescence imaging makes it possible to detect low-grade intraepithelial neoplasia in Barrett’s mucosa, with fewer biopsies. 6) Patients with Barrett’s esophagus with a length of over 3 cm had a significantly greater prevalence of dysplasia in comparison with those in the whom the Barrett’s segment was shorter than 3 cm (23 % vs. 9 %, P = 0.0001).
With regard to gastric tumors, 1) Helicobacter pylori eradication can significantly reduce the development of gastric cancer, but only in patients without precancerous lesions. 2) Intestinal metaplasia types II and III have been shown to have a higher rate of progression to low-grade dysplasia than type I. 3) With regard to screening in asymptomatic individuals, serum pepsinogen may represent an alternative to conventional fluoroscopy methods. 4) In patients who have undergone esophagectomy for esophageal cancer, annual follow-up endoscopies are vital for detecting early secondary gastric cancer and ulcerations in which curative treatment is possible. 5) High-resolution endoscopy allows more precise diagnosis of early gastric cancer. The presence of irregular minute vessels and variations in vessel caliber were found to be specific of early gastric cancer. The small regular pattern of sulci and ridges was observed significantly more frequently in differentiated carcinoma than in undifferentiated carcinoma. 6) Infrared-ray electronic endoscopy combined with indocyanine green injection appears to be effective in detecting sentinel nodes that contain metastases in patients with gastric cancer. 7) Gastric adenocarcinoma was found to show specific changes in the fluorescence spectra emitted, in comparison with normal gastric mucosa. However, there was wide variation in the emitted autofluorescence spectra in gastric cancer with signet-ring cells in comparison with normal mucosa.
References
- 1 Ikeda M, Natsugoe S, Ueno S. et al . Significant host- and tumor-related factors for predicting prognosis in patients with esophageal carcinoma. Ann Surg. 2003; 238 197-202
- 2 Shimada H, Nabeya Y, Okazumi S. et al . Elevation of preoperative serum C-reactive protein level is related to poor prognosis in esophageal squamous cell carcinoma. J Surg Oncol. 2003; 83 248-252
- 3 Shimada H, Oohira G, Okazumi S. et al . Thrombocytosis associated with poor prognosis in patients with esophageal carcinoma. J Am Coll Surg. 2004; 198 737-741
- 4 Siemsen M, Svendsen L B, Knigge U. et al . A prospective randomized comparison of curved array and radial echoendoscopy in patients with esophageal cancer. Gastrointest Endosc. 2003; 58 671-676
- 5 Mariette C, Balon J M, Maunoury V. et al . Value of endoscopic ultrasonography as a predictor of long-term survival in oesophageal carcinoma. Br J Surg. 2003; 90 1367-1372
- 6 Vazquez-Sequeiros E, Wiersema M J, Clain J E. et al . Impact of lymph node staging on therapy of esophageal carcinoma. Gastroenterology. 2003; 125 1626-1635
- 7 Chang K J, Soetikno R M, Bastas D. et al . Impact of endoscopic ultrasound combined with fine-needle aspiration biopsy in the management of esophageal cancer. Endoscopy. 2003; 35 962-966
- 8 Sakamoto F, Natsugoe S, Yoshinaka H. et al . Endosonographic detection of mediastinal lymph node metastasis in superficial carcinoma of the esophagus: assessment by type classification and histogram. J Gastroenterol. 2004; 39 7-13
- 9 May A, Gunter E, Roth F. et al . Accuracy of staging in early oesophageal cancer using high resolution endoscopy and high resolution endosonography: a comparative, prospective, and blinded trial. Gut. 2004; 53 634-640
- 10 Yoon Y C, Lee K S, Shim Y M. et al . Metastasis to regional lymph nodes in patients with esophageal squamous cell carcinoma: CT versus FDG-PET for presurgical detection prospective study. Radiology. 2003; 227 764-770
- 11 Kneist W, Schreckenberger M, Bartenstein P. et al . Positron emission tomography for staging esophageal cancer: does it lead to a different therapeutic approach?. World J Surg. 2003; 27 1105-1112
- 12 Rasanen J V, Sihvo E I, Knuuti M J. et al . Prospective analysis of accuracy of positron emission tomography, computed tomography, and endoscopic ultrasonography in staging of adenocarcinoma of the esophagus and the esophagogastric junction. Ann Surg Oncol. 2003; 10 954-960
- 13 Niepsuj K, Niepsuj G, Cebula W. et al . Autofluorescence endoscopy for detection of high-grade dysplasia in short-segment Barrett’s esophagus. Gastrointest Endosc. 2003; 58 715-719
- 14 Yoshida T, Inoue H, Usui S. et al . Narrow-band imaging system with magnifying endoscopy for superficial esophageal lesions. Gastrointest Endosc. 2004; 59 288-295
- 15 Shimizu Y, Tsukagoshi H, Fujita M. et al . Head and neck cancer arising after endoscopic mucosal resection for squamous cell carcinoma of the esophagus. Endoscopy. 2003; 35 322-326
- 16 Matsubara T, Yamada K, Nakagawa A. Risk of second primary malignancy after esophagectomy for squamous cell carcinoma of the thoracic esophagus. J Clin Oncol. 2003; 21 4336-4341
- 17 Stepinac T, Felley C, Jornod P. et al . Endoscopic fluorescence detection of intraepithelial neoplasia in Barrett’s esophagus after oral administration of aminolevulinic acid. Endoscopy. 2003; 35 663-668
- 18 Gopal D V, Lieberman D A, Magaret N. et al . Risk factors for dysplasia in patients with Barrett’s esophagus (BE): results from a multicenter consortium. Gastrointest Endosc. 2003; 57 823-829
- 19 Dar M S, Goldblum J R, Rice T W, Falk G W. Can extent of high grade dysplasia in Barrett’s oesophagus predict the presence of adenocarcinoma at oesophagectomy?. Gut. 2003; 52 486-489
- 20 Rugge M, Cassaro M, di Mario F. et al . The long term outcome of gastric non-invasive neoplasia. Gut. 2003; 52 1111-1116
- 21 Wong B C, Lam S K, Wong W M. et al . Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA. 2004; 291 187-194
- 22 Dinis-Ribeiro M, Lopes C, da Costa-Pereira A. et al . A follow up model for patients with atrophic chronic gastritis and intestinal metaplasia. J Clin Pathol. 2004; 57 177-182
- 23 Miki K, Morita M, Sasajima M. et al . Usefulness of gastric cancer screening using the serum pepsinogen test method. Am J Gastroenterol. 2003; 98 735-739
- 24 Motoyama S, Saito R, Kitamura M. et al . Prospective endoscopic follow-up results of reconstructed gastric tube. Hepatogastroenterology. 2003; 50 666-669
- 25 Dinis-Ribeiro M, da Costa-Pereira A, Lopes C. et al . Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc. 2003; 57 498-504
- 26 Ajisaka H, Miwa K. Micrometastases in sentinel nodes of gastric cancer. Br J Cancer. 2003; 89 676-680
- 27 Nimura H, Narimiya N, Mitsumori N. et al . Infrared ray electronic endoscopy combined with indocyanine green injection for detection of sentinel nodes of patients with gastric cancer. Br J Surg. 2004; 91 575-579
- 28 Kim M C, Kim H H, Jung G J. et al . Lymphatic mapping and sentinel node biopsy using 99mTc tin colloid in gastric cancer. Ann Surg. 2004; 239 383-387
- 29 Ishigami S, Natsugoe S, Tokuda K. et al . Clinical impact of micrometastasis of the lymph node in gastric cancer. Am Surg. 2003; 69 573-577
- 30 Ohno S, Inagawa H, Dhar D K. et al . The degree of macrophage infiltration into the cancer cell nest is a significant predictor of survival in gastric cancer patients. Anticancer Res. 2003; 23 5015-5022
- 31 Kitayama J, Hatano K, Kaisaki S. et al . Hyperlipidaemia is positively correlated with lymph node metastasis in men with early gastric cancer. Br J Surg. 2004; 91 191-198
- 32 Blackshaw G R, Barry J D, Edwards P. et al . Laparoscopy significantly improves the perceived preoperative stage of gastric cancer. Gastric Cancer. 2003; 6 225-229
- 33 Imai M, Kondo Y, Osawa S. et al . Clinicopathological characteristics of superficial spreading type early gastric cancer. J Surg Oncol. 2003; 83 94-98
- 34 Otsuka Y, Niwa Y, Ohmiya N. et al . Usefulness of magnifying endoscopy in the diagnosis of early gastric cancer. Endoscopy. 2004; 36 165-169
- 35 Habermann C R, Weiss F, Riecken R. et al . Preoperative staging of gastric adenocarcinoma: comparison of helical CT and endoscopic US. Radiology. 2004; 230 465-471
- 36 Mayinger B, Jordan M, Horbach T. et al . Evaluation of in vivo endoscopic autofluorescence spectroscopy in gastric cancer. Gastrointest Endosc. 2004; 59 191-198
- 37 Mataki N, Nagao S, Kawaguchi A. et al . Clinical usefulness of a new infrared videoendoscope system for diagnosis of early stage gastric cancer. Gastrointest Endosc. 2003; 57 336-342
- 38 Kodera Y, Ito S, Yamamura Y. et al . Follow-up surveillance for recurrence after curative gastric cancer surgery lacks survival benefit. Ann Surg Oncol. 2003; 10 898-902
- 39 Park Y S, Park S W, Kim T I. et al . Endoscopic enucleation of upper GI submucosal tumors by using an insulated-tip electrosurgical knife. Gastrointest Endosc. 2004; 59 409-415
- 40 Wong N A, Young R, Malcomson R D. et al . Prognostic indicators for gastrointestinal stromal tumours: a clinicopathological and immunohistochemical study of 108 resected cases of the stomach. Histopathology. 2003; 43 118-126
M. Moretó, M. D.
Servicio de Gatroenterología y Hepatología, Hospital de Cruces
Plaza de Cruces · 48930 Baracaldo · Spain
Fax: + 34-94-600-6358
eMail: mmoretoc@wanadoo.es