Utility of Chromoendoscopy with Lugol Solution Spraying in Early Detection of Esophageal Squamous Cell Carcinoma and Dysplasia

• Published in: The Showa University Journal of Medical Sciences Vol. 15; no. 2; pp. 183 - 189
• Main Authors: ITO, Hiroaki, KANEKO, Kazuhiro, KONISHI, Kazuo, YAMAMOTO, Taikan, KATAGIRI, Atushi, KUSHIMA, Miki, HOMMA, Ikuo, MITAMURA, Keiji
• Format: Journal Article
• Language: English
• Published: The Showa University Society 2003
• Subjects: carcinogenesis; esophagus; Lugol staining; squamous cell carcinoma; videoendoscopy
• ISSN: 0915-6380; 2185-0968
• DOI: 10.15369/sujms1989.15.183

Patients with esophageal squamous cell carcinoma (ESCC) have a poor prognosis, making early detection vital. Endoscopic screening to detect early signs of ESCC with the hope of preventing disease progression has not yet been established. The aim of this prospective study was to investigate Chromoscopy with Lugol solution spraying as a screening method. A sample group of 1028 asymptomatic subjects, comprising 528 males and 500 females, underwent the videoendoscopy. Biopsies were performed endoscopically on any Lugol-unstained lesions detected by the video screening. ESCC originates from esophageal dysplasia. Therefore, we compared the detection rate of dysplastic lesions using routine endoscopy with that found by chromoendoscopy using Lugol staining. In addition, the clinicopathological characteristics of dysplastic lesions containing ESCC were investigated. Out of 1028 patients, 203 (20%) had Lugol-unstained lesions including 29 (2.8%) dysplastic lesions and 174 (17%) esophagitis. Of the 29 patients with dysplastic lesions, 20 were male and 9 were female. The dysplastic lesions comprised 18 showing low-grade dysplasia (LGD) and 11 showing high-grade dysplasia (HGD) with two intraepithelial carcinomas detected. Sixteen of the 29 dysplastic lesions (55%) measured 5 mm or less in diameter, and 59% of these lesions were located in the middle third of the esophagus. Dysplastic lesions containing intraepithelial carcinoma were detected in 3 of the 1028 biopsied specimens (0.3%) by routine endoscopic observation and in 29 specimens (2.8%) by endoscopic observation with Lugol solution spraying; this difference was significant between the two groups (p<0.0001) . Esophageal dysplastic lesions were therefore found in 2.8% of asymptomatic patients. From this study, we conclude that Chromoendoscopy with Lugol solution spraying is a useful screening procedure for the early detection of ESCC.