Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 May 21;22(1):259.
doi: 10.1186/s12876-022-02335-5.

Optical biopsy for esophageal squamous cell neoplasia by using endocytoscopy

Yoshihiko Shimoda  1 , Yuichi Shimizu  2   3 , Hiroaki Takahashi  4 , Satoshi Okahara  4 , Takakazu Miyake  4 , Shin Ichihara  5 , Ikko Tanaka  1 , Masaki Inoue  1 , Sayoko Kinowaki  1 , Masayoshi Ono  6 , Keiko Yamamoto  6 , Shoko Ono  7 , Naoya Sakamoto  1
Affiliations
Multicenter Study

Optical biopsy for esophageal squamous cell neoplasia by using endocytoscopy

Yoshihiko Shimoda et al. BMC Gastroenterol. .

Abstract

Background: Endocytoscopy (ECS) enables microscopic observation in vivo for the gastrointestinal mucosa; however, there has been no prospective study in which the diagnostic accuracy of ECS for lesions that have not yet undergone histological diagnosis was evaluated. We conducted a surveillance study for patients in a high-risk group of esophageal squamous cell carcinoma (ESCC) and evaluated the in vivo histological diagnostic accuracy of ECS.

Methods: This study was a multicenter prospective study. We enrolled 197 patients in the study between September 1, 2019 and November 30, 2020. The patients first underwent white light imaging and narrow band imaging, and ultra-high magnifying observation was performed if there was a lesion suspected to be an esophageal tumor. Endoscopic submucosal dissection (ESD) was later performed for lesions that were diagnosed to be ESCC by ECS without biopsy. We evaluated the diagnostic accuracy of ECS for esophageal tumorous lesions.

Results: ESD was performed for 37 patients (41 lesions) who were diagnosed as having ESCC by ECS, and all of them were histopathologically diagnosed as having ESCC. The sensitivity [95% confidence interval (CI)] was 97.6% (87.7-99.7%), specificity (95% CI) was 100% (92.7-100%), diagnostic accuracy (95% CI) was 98.9% (94.0-99.8%), positive predictive value (PPV) (95% CI) was 100% (91.4-100%) and negative predictive value (NPV) (95% CI) was 98.0% (89.5-99.7%).

Conclusions: ECS has a high diagnostic accuracy and there were no false positives in cases diagnosed and resected as ESCC. Optical biopsy by using ECS for esophageal lesions that are suspected to be tumorous is considered to be sufficient in clinical practice.

Keywords: Diagnostic accuracy; Endocytoscopy; Esophageal cancer; Intraepithelial neoplasia; Optical biopsy.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Esophageal EC classification. a EC1a (normal) shows regularly arranged large rhomboid-shaped cells. b EC1b (esophagitis) shows blunted edges and more rounded cells. c EC2 (intraepithelial neoplasia) shows an increase in cellular density but still with a recognizable cell structure. d EC3 (squamous cell carcinoma) shows complete loss of cellular structure with a significant increase in cellular density
Fig. 2
Fig. 2
Flow chart showing diagnoses of the 197 lesions by using white-light imaging endoscopic, magnifying endoscopy combined with narrow-band imaging and ultra-high magnifying endoscopy. ESD, endoscopic submucosal dissection; WLI white-light imaging, NBI narrow-band imaging
Fig. 3
Fig. 3
A representative case of SCC in EC3: A Endoscopic view by WLI. Redness and a slightly depressed lesion (yellow arrows) can be seen. B Endoscopic view by NBI. A brownish area with background coloration (white arrows) can be seen. C Endocytoscopic image of the lesion. EC classification was graded to be 3 by the endoscopist. D The resected specimen histologically revealed SCC (red line). E Photomicrograph of the resected specimen shows carcinoma in situ (H&E, orig. mag. × 40). SCC, squamous cell carcinoma; EC3 EC classification 3, WLI white-light imaging, NBI barrow-band imaging
Fig. 4
Fig. 4
A representative case of intraepithelial neoplasia: A Endoscopic view by WLI. A faintly reddish lesion (yellow arrows can be seen. B Endoscopic view by NBI. A brownish area without background coloration (white arrows) can be seen. C Endocytoscopic image of the lesion. EC classification was graded to be 2 by the endoscopist. D Photomicrograph of the biopsied specimen shows atypical cells (H&E, orig. mag. × 40). EC2 EC classification 2, WLI white-light imaging, NBI narrow-band imaging
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Takahashi M, Shimizu Y, Ono M, Suzuki M, Omori S, Yoshida T, et al. Endoscopic diagnosis of early neoplasia of the esophagus with narrow band imaging: correlations among background coloration and iodine staining findings. J Gastroenterol Hepatol. 2014;29:762–768. doi: 10.1111/jgh.12477. - DOI - PubMed
    1. Nagami Y, Tominaga K, Machida H, Nakatani M, Kameda N, Sugimori S, et al. Usefulness of non-magnifying narrow-band imaging in screening of early esophageal squamous cell carcinoma: a prospective comparative study using propensity score matching. Am J Gastroenterol. 2014;109:845–854. doi: 10.1038/ajg.2014.94. - DOI - PMC - PubMed
    1. Goda K, Dobashi A, Yoshimura N, Aihara H, Kato M, Sumiyama K, et al. Dual-focus versus conventional magnification endoscopy for the diagnosis of superficial squamous neoplasms in the pharynx and esophagus: a randomized trial. Endoscopy. 2016;48:321–329. doi: 10.1055/s-0035-1569644. - DOI - PubMed
    1. Inoue H, Sasajima K, Kaga M, Sugaya S, Sato Y, Wada Y, et al. Endoscopic in vivo evaluation of tissue atypia in the esophagus using a newly designed integrated endocytoscope: a pilot trial. Endoscopy. 2006;38:891–895. doi: 10.1055/s-2006-944667. - DOI - PubMed
    1. Minami H, Inoue H, Yokoyama A, Ikeda H, Satodate H, Hamatani S, et al. Recent advancement of observing living cells in the esophagus using CM double staining: endocytoscopic atypia classification. Dis Esophagus. 2012;25:235–241. doi: 10.1111/j.1442-2050.2011.01241.x. - DOI - PubMed

Publication types

MeSH terms