Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites
Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites
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DOI：
10.1002/cncr.20482
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发表时间：
2004-09-15
期刊：
影响因子：
6.2
通讯作者：
Yoshida, S
中科院分区：
文献类型：
--
作者：
Muto, M;Nakane, M;Yoshida, S
背景。头颈鳞状细胞癌通常在晚期才被诊断出来，此类恶性肿瘤患者的预后很差。在早期阶段检测到这些病变（例如原位癌）对患者来说显然是有益的。然而，在常规内窥镜检查中，即使内窥镜多次穿过口腔和咽部，也很难检测到头颈部粘膜部位的原位癌。方法。目前的临床研究是在常规内窥镜筛查或监测过程中进行的。作者使用了一种称为窄带成像 (NBI) 的新型光学技术，该技术允许使用反射光对器官表面的微血管结构进行无创可视化。结果。 2002年4月至2003年8月期间，18名患者连续出现34个浅表病变。 5 名患者（28%）发现多灶性癌。接受检查的患者的中位年龄为 59.5 岁（范围为 43-71 岁），所有患者中 83% 为男性。所有病变在放大 NBI 上均表现出微血管增殖模式。 13 名患者共 29 个病灶，在全身麻醉下接受了内镜切除术。梨状窦是最常见的原发部位（66%；29 个病变中的 19 个）。肿瘤中位直径为20朗姆（范围，1.3-40毫米）。 21个病灶（72%）经组织学证实为原位癌，其余病灶显示上皮下微浸润（0.05-1毫米）的证据。仅在一处病变中观察到血管侵犯。中位住院时间为 10 天（范围为 4-18 天）。所有患者均已出院，无严重并发症。中位随访8个月（范围1-16个月）后，没有出现局部疾病复发的病例。结论。作者强调了内窥镜检测口咽和下咽粘膜部位浅表癌的重要性。 NBI 是一种有前途且潜在强大的工具，可用于在常规内窥镜检查中早期识别癌症。 (C) 2004 年美国癌症协会。
BACKGROUND. Head and neck squamous cell carcinoma typically is diagnosed at an advanced stage, and the prognosis for patients with this type of malignancy is poor. Detection of these lesions at an earlier stage (e.g., as carcinoma in situ) would be of clear benefit to patients. However, it has been extremely difficult to detect carcinoma in situ at head and neck mucosal sites during routine endoscopy, even after numerous passes of the endoscope through the oral cavity and the pharynx.METHODS. The current clinical investigation was performed during routine endoscopic screening or surveillance procedures. The authors used a novel optical technique, known as narrowband imaging (NBI) that allows noninvasive visualization of the microvascular structure of an organ's surface using reflected light.RESULTS. Between April 2002 and August 2003, 34 consecutive superficial lesions were found in 18 patients. Multifocal carcinoma was found in 5 patients (28%). The median age of the patients examined was 59.5 years (range, 43-71 years), and 83% of all patients were male. All lesions exhibited a microvascular proliferation pattern on magnified NBI. Thirteen patients with a combined total of 29 lesions underwent endoscopic resection under general anesthesia. The pyriform sinus was the most frequent primary site (66%; 19 of 29 lesions). The median tumor diameter was 20 rum (range, 1.3-40 mm). Twenty-one lesions (72%) were histologically confirmed to be carcinoma in situ, and the remaining lesions showed evidence of microinvasion (0.05-1 mm) beneath the epithelium. Vascular invasion was observed in only one lesion. The median hospital stay was 10 days (range, 4-18 days). All patients were discharged without severe complications. After a median follow-up period of 8 months (range, 1-16 months), there were no cases of local disease recurrence.CONCLUSION. The authors stress the importance of endoscopic detection of superficial carcinoma at oropharyngeal and hypopharyngeal mucosal sites. NBI is a promising and potentially powerful tool for identifying carcinomas at an earlier stage during routine endoscopic examination. (C) 2004 American Cancer Society.