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Microvascular structural changes in esophageal squamous cell carcinoma pathology according to intrapapillary capillary loop types under magnifying endoscopy - PubMed

  • ️Mon Jan 01 2024

Microvascular structural changes in esophageal squamous cell carcinoma pathology according to intrapapillary capillary loop types under magnifying endoscopy

Wei-Yang Shu et al. World J Gastrointest Oncol. 2024.

Abstract

Background: The intrapapillary capillary loop (IPCL) characteristics, visualized using magnifying endoscopy, are commonly assessed for preoperative evaluation of the infiltration depth of esophageal squamous cell carcinoma (ESCC). Japan Esophageal Society (JES) classification is the most widely used classification. Microvascular structural changes are evaluated by magnifying endoscopy for the presence or absence of each morphological factor: tortuosity, dilatation, irregular caliber, and different shapes. However, the pathological characteristics of IPCLs have not been thoroughly investigated, especially the microvascular structures corresponding to the deepest parts of the lesions' infiltration.

Aim: To investigate differences in pathological microvascular structures of ESCC, which correspond to the deepest parts of the lesions' infiltration.

Methods: Patients with ESCC and precancerous lesions diagnosed at Peking University Third Hospital were enrolled between January 2019 and April 2023. Patients first underwent magnified endoscopic examination, followed by endoscopic submucosal dissection or surgical treatment. Pathological images were scanned using a three-dimensional slice scanner, and the pathological structural differences in different types, according to the JES classification, were analyzed using nonparametric tests and t-tests.

Results: The 35 lesions were divided into four groups according to the JES classification: A, B1, B2, and B3. Statistical analyses revealed significant differences (a P < 0.05) in the short and long calibers, area, location, and density between types A and B. Notably, there were no significant differences in these parameters between types B1 and B2 and between types B2 and B3 (P > 0.05). However, significant differences in the short calibers, long calibers, and area of IPCL were observed between types B1 and B3 (a P < 0.05); no significant differences were found in the density or location (P > 0.05).

Conclusion: Pathological structures of IPCLs in the deepest infiltrating regions differ among various IPCL types classified by the JES classification under magnifying endoscopy, especially between the types A and B.

Keywords: Esophageal squamous cell carcinoma; Intrapapillary capillary loop; Magnifying endoscopy; Pathological characteristics; The Japan Esophageal Society classification.

©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1

Intrapapillary capillary loops in superficial esophageal lesions under magnifying endoscopy and photographic recordings of both fresh and fixed specimens. A: Intrapapillary capillary loops (IPCLs) of type A under narrow-band imaging or blue laser imaging combined with magnifying endoscopy (ME-NBI/BLI) (magnification: × 80); B: IPCLs of type B1 under ME-NBI/BLI (magnification: × 80); C: IPCLs of type B2 under ME-NBI/BLI (magnification: × 80); D: IPCLs of type B3 under ME-NBI/BLI (magnification: × 80); E: Flesh specimen after endoscopic resection; F: Pathologically fixed specimen with the red line marking the extent of the cancer and the yellow line marking the extent of intraepithelial neoplasia.

Figure 2
Figure 2

Pathological data collection using Case Viewer software. A: Pathological slide stained with hematoxylin and eosin (magnification: × 100); B: Pathological slide stained for CD34 (magnification: × 100); C: Pathological slide stained for D2-40 (magnification: × 100); D: Measurement of intrapapillary capillary loop (IPCL)-related characteristics (red A: Apical distance from the vertex of the IPCL to the basement membrane; red B: Thickness of the epithelial layer); E: Enlarged orange region in picture D (red C: Short caliber of the IPCL; red D: Long caliber of the IPCL; and the region enclosed by the blue line is the area of the IPCL); F: Pathological slide stained for CD34 (magnification: × 800); the transverse diameter of each field of view was 719.8 μm; G: Pathological slide stained for CD34 (magnification: × 2000); the transverse diameter of each field of view is 287.9 μm.

Figure 3
Figure 3

Nonparametric test results in types A, B1, B2, and B3 for short caliber, long caliber, area, density, and location of intrapapillary capillary loops. A: Nonparametric test in types A, B1, B2, and B3 for the short caliber of intrapapillary capillary loops (IPCLs); B: Nonparametric test in types A, B1, B2, and B3 for long caliber of IPCLs; C: Nonparametric test in types A, B1, B2, and B3 for area of IPCLs; D: Nonparametric test in types A, B1, B2, and B3 for density of IPCLs; E: Nonparametric test in types A, B1, B2, and B3 for location of IPCLs. aP < 0.05; NS: P > 0.05.

Figure 4
Figure 4

Nonparametric test results in types A, B1/B2, and B3 for short caliber, long caliber, area, density, and location of Intrapapillary capillary loops. A: Nonparametric test in types A, B1/B2, and B3 for short caliber of Intrapapillary capillary loops (IPCLs); B: Nonparametric test in types A, B1/B2, and B3 for long caliber of IPCLs; C: Nonparametric test in types A, B1/B2, and B3 for area of IPCLs; D: Nonparametric test in types A, B1/B2, and B3 for density of IPCLs; E: Nonparametric test in types A, B1/B2, and B3 for location of IPCLs. bP < 0.05; NS: P > 0.05.

Figure 5
Figure 5

T-test results between types B1 and B2 for short caliber, long caliber, area, density, and location of Intrapapillary capillary loops. A: Nonparametric test in types B1 and B2 for short caliber of intrapapillary capillary loops (IPCLs); B: Nonparametric test in types B1 and B2 for long caliber of IPCLs; C: Nonparametric test in types B1 and B2 for area of IPCLs; D: Nonparametric test in types B1 and B2 for density of IPCLs; E: Nonparametric test in types B1 and B2 for location of IPCLs. cP < 0.05; NS: P > 0.05.

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