Detection and classification of early squamous cell esophageal cancer

TLDR

Lugol's solution staining improves diagnostic precision for flat esophageal lesions. The study analyzed 230 T1 thoracic esophageal cancer cases resected from 1985 to 1996. Mucosal esophageal cancer outperforms submucosal cancer in 5‑year survival (84% vs 64%), lymph node metastasis (2% vs 42%) and vascular invasion (8% vs 79%); 93% of 0–IIb and 80% of 0–IIc lesions are mucosal, and early cancer is best detected via esophagoscopy for mild symptoms, annual screening of high‑risk groups, and Lugol staining of abnormal findings.

Abstract

The authors analyzed 230 cases of T1 cancer of the thoracic esophagus resected in our surgical department between 1985 and 1996. This study showed that mucosal cancer was superior to submucosal cancer with respect to the 5-year survival rate (84% vs 64%), the incidence of lymph node metastasis (2% vs 42%) and the incidence of vascular invasion (8% vs 79%); therefore, the true early cancer of the esophagus can be defined as mucosal cancer of the esophagus. As for endoscopic classification, 93% of the 0–IIb subtype lesion and 80% of the 0–IIc subtype were mucosal cancer. Endoscopic staining with Lugol's solution can produce more precise information in the diagnosis of such flat lesions. Important points in screening for the detection of mucosal cancer of the esophagus include: (i) esophagoscopy for patients with only slight esophageal symptoms; (ii) annual endoscopic examination for high-risk populations; and (iii) endoscopic staining with Lugol's solution for abnormal findings on conventional endoscopy.