Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining: High-grade intra-epithelial neoplasia turns pink within a few minutes

Yuichi Shimizu, Tai Omori, Akira Yokoyama, Takeshi Yoshida, Jojo Hirota, Yuji Ono, Junji Yamamoto, Mototsugu Kato, Masahiro Asaka

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Background and Aim: The ability to detect early squamous neoplasia of the esophagus can be enhanced considerably by iodine staining during endoscopic examination; however, there has been no study on distinguishing high-grade intra-epithelial squamous neoplasia from low-grade dysplasia by endoscopic examination. We assumed that high-grade intra-epithelial neoplasia could be identified as iodine-unstained areas more distinct and reddish than low-grade dysplasia after the brown color of iodine solution has faded, because there is almost no remaining glycogen-containing epithelium in high-grade intra-epithelial neoplasia. Methods: Seventy-nine patients who were found to have demarcated iodine-unstained areas (0.5 cm to 1.5 cm at widest part, 121 lesions in total) were studied. After a target lesion was found, the lesion was observed for about 3 min and its discoloration was evaluated. If a light-pink part appeared in the iodine-unstained area, the lesion was regarded as being positive for pink color. If no light-pink part was observed in the lesion within 3 min, the lesion was regarded as being negative for pink color. Results: Thirty-four (87.2%) of the 39 lesions diagnosed as pink-color positive were histologically confirmed to be high-grade intra-epithelial squamous neoplasia or squamous cell carcinoma, whereas only three (3.7%) of the 82 lesions diagnosed as negative for pink color were histologically confirmed to be high-grade intra-epithelial squamous neoplasia (P < 0.0001). Using the pink-color sign as a diagnostic index for high-grade intra-epithelial squamous neoplasia and squamous cell carcinoma, sensitivity was 91.9% and specificity was 94.0%. Conclusion: By using the pink-color sign for endoscopic diagnosis, accurate diagnosis without endoscopic biopsy for iodine-unstained areas was possible.

Original languageEnglish
Pages (from-to)546-550
Number of pages5
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume23
Issue number4
DOIs
Publication statusPublished - 2008

Fingerprint

Iodine
Esophagus
Color
Staining and Labeling
Neoplasms
Squamous Cell Carcinoma
Light
Glycogen
Epithelium
Biopsy

Keywords

  • Endoscopic diagnosis
  • Esophageal cancer
  • Esophageal dysplasia
  • Iodine staining

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining : High-grade intra-epithelial neoplasia turns pink within a few minutes. / Shimizu, Yuichi; Omori, Tai; Yokoyama, Akira; Yoshida, Takeshi; Hirota, Jojo; Ono, Yuji; Yamamoto, Junji; Kato, Mototsugu; Asaka, Masahiro.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 23, No. 4, 2008, p. 546-550.

Research output: Contribution to journalArticle

Shimizu, Yuichi ; Omori, Tai ; Yokoyama, Akira ; Yoshida, Takeshi ; Hirota, Jojo ; Ono, Yuji ; Yamamoto, Junji ; Kato, Mototsugu ; Asaka, Masahiro. / Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining : High-grade intra-epithelial neoplasia turns pink within a few minutes. In: Journal of Gastroenterology and Hepatology (Australia). 2008 ; Vol. 23, No. 4. pp. 546-550.
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T1 - Endoscopic diagnosis of early squamous neoplasia of the esophagus with iodine staining

T2 - High-grade intra-epithelial neoplasia turns pink within a few minutes

AU - Shimizu, Yuichi

AU - Omori, Tai

AU - Yokoyama, Akira

AU - Yoshida, Takeshi

AU - Hirota, Jojo

AU - Ono, Yuji

AU - Yamamoto, Junji

AU - Kato, Mototsugu

AU - Asaka, Masahiro

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AB - Background and Aim: The ability to detect early squamous neoplasia of the esophagus can be enhanced considerably by iodine staining during endoscopic examination; however, there has been no study on distinguishing high-grade intra-epithelial squamous neoplasia from low-grade dysplasia by endoscopic examination. We assumed that high-grade intra-epithelial neoplasia could be identified as iodine-unstained areas more distinct and reddish than low-grade dysplasia after the brown color of iodine solution has faded, because there is almost no remaining glycogen-containing epithelium in high-grade intra-epithelial neoplasia. Methods: Seventy-nine patients who were found to have demarcated iodine-unstained areas (0.5 cm to 1.5 cm at widest part, 121 lesions in total) were studied. After a target lesion was found, the lesion was observed for about 3 min and its discoloration was evaluated. If a light-pink part appeared in the iodine-unstained area, the lesion was regarded as being positive for pink color. If no light-pink part was observed in the lesion within 3 min, the lesion was regarded as being negative for pink color. Results: Thirty-four (87.2%) of the 39 lesions diagnosed as pink-color positive were histologically confirmed to be high-grade intra-epithelial squamous neoplasia or squamous cell carcinoma, whereas only three (3.7%) of the 82 lesions diagnosed as negative for pink color were histologically confirmed to be high-grade intra-epithelial squamous neoplasia (P < 0.0001). Using the pink-color sign as a diagnostic index for high-grade intra-epithelial squamous neoplasia and squamous cell carcinoma, sensitivity was 91.9% and specificity was 94.0%. Conclusion: By using the pink-color sign for endoscopic diagnosis, accurate diagnosis without endoscopic biopsy for iodine-unstained areas was possible.

KW - Endoscopic diagnosis

KW - Esophageal cancer

KW - Esophageal dysplasia

KW - Iodine staining

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