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Lugol chromoendoscopy combined with brush cytology in patients at risk for esophageal squamous cell carcinoma

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Abstract

Background and study aims

Patients with achalasia or malignancies of the head and neck are at increased risk for esophageal squamous cell carcinoma. The discussion of a screening and surveillance program is controversial. The aim of the present study was to determine the diagnostic potential of Lugol chromoendoscopy combined with brush cytology to diagnose esophageal squamous cell carcinoma and high-grade dysplasia. Secondly, the benefit of additional biomarkers was investigated.

Patients and methods

A total of 61 patients (21 patients with achalasia and 40 patients with malignancies of the head and neck) were included. Chromoendoscopy with 1.2% Lugol iodine solution with targeted biopsies and brush cytology processed by digital image cytometry (DICM) and fluorescence in situ hybridization (FISH) from unstained lesions (USLs) and stained mucosa were performed.

Results

Six of the 61 patients had USLs ≥2 cm. Four patients had high-grade dysplasia (HGD) or carcinoma in situ (CIS). One patient with HGD and one patient with CIS were detected only after Lugol chromoendoscopy. The sensitivity and specificity for detected HGD or CIS in USLs ≥2 cm were 100% and 96.5%. No dysplasia was found in USLs <2 cm. DNA ploidy by DNA cytometry and p53 loss of heterozygosity (LOH) by fluorescence in situ hybridization showed no additional impact on diagnostic accuracy.

Conclusions

Lugol chromoendoscopy enhances the detection rate of high-risk lesions with dysplasia or carcinoma in situ in large unstained lesions. Biomarkers such as aneuploidy and p53 LOH from brush cytology were not of additional benefit in this setting.

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References

  1. Streitz JM, Ellis FH, Gibb SP et al (1995) Achalasia and squamous cell carcinoma of the oesophagus: analysis of 241 patients. Ann Thorac Surg 59:1604–1609

    Article  PubMed  Google Scholar 

  2. Pelucchi C, Gallus S, Garavello W et al (2006) Cancer risk associated with alcohol and tabacco use: focus on upper aero-digestive tract and liver. Alcohol Res Health 29:193–198

    PubMed  Google Scholar 

  3. Wang GQ, Jiao GG, Chang FB et al (2004) Long-term results of operation for 420 patients with early squamous cell oesophageal carcinoma discovered by screening. Ann Thorac Surg 77:1740–1744

    Article  PubMed  Google Scholar 

  4. Dawsey SM, Fleischer DE, Wang GQ et al (1998) Mucosal iodine staining improves endoscopic visualisation of squamous dysplasia and squamous cell carcinoma of the esophagus in Linxian, China. Cancer 83:220–231

    Article  CAS  PubMed  Google Scholar 

  5. Dubuc J, Legoux JL, Winnock M et al (2006) Endoscopic screening for esophageal squamous-cell carcinoma in high-risk patients: a prospective study conducted in 62 french endoscopy centers. Endoscopy 38:690–695

    Article  CAS  PubMed  Google Scholar 

  6. Porschen R, Molsberger G, Kühn A et al (1995) Achalasia-associated squamous cell carcinoma of the oesophagus: flow-cytometric and histological evaluation. Gastroenterology 108:545–549

    Article  CAS  PubMed  Google Scholar 

  7. Levine AJ, Momand J, Finlay CA (1991) The p53 tumor suppressor gene. Nature (Lond) 351:453–456

    Article  CAS  Google Scholar 

  8. Shi ST, Yang GY, Wang LD et al (1999) Role of p53 gene mutations in human oesophageal carcinogenesis: results from immunohistochemical mutation analyses of carcinomas and nearby non-cancerous lesions. Carcinogenesis 20:591–597

    Article  CAS  PubMed  Google Scholar 

  9. Borovicka J, Schönegg R, Kradolfer D et al (2005) Combined digital image cytometry with fluorescence in situ hybridization of brush cytology identifies patients with Barrett’s esophagus at increased for risk neoplastic progression. Gastrointest Endosc 61(5):103

    Google Scholar 

  10. Haroske G, Meyer W, Theissig F et al (1998) Remote quantitation server for quality assurance in DNA ploidy analysis. Anal Quant Cytol Histol 20:302–312

    CAS  PubMed  Google Scholar 

  11. Haroske G, Baak JP, Danielsen H et al (2001) Fourth updated ESACP consensus report on diagnostic DNA image cytometry. Anal Cell Pathol 23:89–95

    CAS  PubMed  Google Scholar 

  12. Muto M, Hironaka S, Nakane M et al (2002) Association of multiple Lugol-voiding Lesions with synchronous and metachronous esophageal squamous cell carcinoma in patients with head and neck cancer. Gastrointest Endosc 56:517–521

    Article  PubMed  Google Scholar 

  13. Yamamuro EM, Cecconello I, Iriya K et al (1999) Lugol dye endoscopy for analysis of esophageal mucosa in achalasia. Hepatogastroenterology 46:1687–1691

    CAS  PubMed  Google Scholar 

  14. Yamamuro EM, Cecconello I, Iriya K et al (2006) Lugol staining and histological evaluation of esophageal mucosa in achalasia. Hepatogastroenterology 53:506–510

    PubMed  Google Scholar 

  15. Reid BJ, Levine DS, Longton G et al (2000) Predictors of progression to cancer in Barrett’s oesophagus: baseline histology and flow cytometry identify low- and high-risk patient subsets. Am J Gastroenterol 95:1669–1676

    CAS  PubMed  Google Scholar 

  16. Kaneko K, Katagiri A, Konishi K et al (2007) Study of p53 gene alteration as a biomarker to evaluate the malignant risk of Lugol-unstained lesion with non-dysplasia in the oesophagus. Br J Cancer 96:492–498

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Medicine I, Cantonal Hospital, St. Gallen, 9007, Switzerland

    D. Boller, U. Zuercher, C. Meyenberger & J. Borovicka

  2. Institute of Pathology, Department of Medicine IV, Cantonal Hospital, St. Gallen, Switzerland

    P. Spieler, R. Schoenegg, J. Neuweiler & D. Kradolfer

  3. Division of Otorhinolaryngology, Department of Medicine III, Cantonal Hospital, St. Gallen, Switzerland

    R. Studer & R. Grossenbacher

Authors
  1. D. Boller
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  2. P. Spieler
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  3. R. Schoenegg
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  4. J. Neuweiler
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  5. D. Kradolfer
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  6. R. Studer
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  7. R. Grossenbacher
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  8. U. Zuercher
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  9. C. Meyenberger
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  10. J. Borovicka
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Corresponding author

Correspondence to D. Boller.

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Boller, D., Spieler, P., Schoenegg, R. et al. Lugol chromoendoscopy combined with brush cytology in patients at risk for esophageal squamous cell carcinoma. Surg Endosc 23, 2748–2754 (2009). https://doi.org/10.1007/s00464-009-0489-0

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  • DOI: https://doi.org/10.1007/s00464-009-0489-0

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