Clinical features of pharyngeal intraepithelial neoplasias and outcomes of treatment by endoscopic submucosal dissection

• Published in: Gastrointestinal endoscopy 2012-12, Vol.76 (6), p.1095-1103
• Main Authors: Kuwabara, Takayasu, MD, Hiyama, Toru, MD, PhD, Oka, Shiro, MD, PhD, Urabe, Yuji, MD, PhD, Tanaka, Shinji, MD, PhD, Yoshihara, Masaharu, MD, PhD, Arihiro, Koji, MD, PhD, Shimamoto, Fumio, MD, PhD, Chayama, Kazuaki, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma in Situ - pathology; Carcinoma in Situ - surgery; Endoscopy; Female; Follow-Up Studies; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Pharyngeal Neoplasms - pathology; Pharyngeal Neoplasms - surgery; Pharyngectomy - methods; Respiratory Mucosa - pathology; Respiratory Mucosa - surgery; Retrospective Studies; Treatment Outcome
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2012.07.032

Background Endoscopic detection of superficial squamous epithelial lesions of the pharynx has increased. Objective To clarify the association between macroscopic and histologic characteristics of intraepithelial pharyngeal neoplasias, and to evaluate the effectiveness of endoscopic submucosal dissection (ESD) for their treatment. Design Retrospective analysis of the features of high-grade dysplasia or carcinoma in situ (HGD/CIS) versus low-grade dysplasia (LGD) and of ESD-based outcomes. Setting Endoscopy department at a university hospital. Patients Fifty-one patients with 66 lesions treated by ESD from November 2007 to March 2011. Results Primary hypopharyngeal lesions were significantly more frequent in HGD/CIS than in LGD (54.1% vs 20.7%, P = .011), and oropharyngeal lesions were significantly less frequent in HGD/CIS (45.9% vs 79.3%, P = .011). HGD/CIS lesions were significantly larger than LGD lesions (median 8 mm vs 4 mm, P < .01). Morphologically, type 0-IIa was significantly more frequent in HGD/CIS lesions than in LGD lesions (37.8% vs 3.4%, P < .001), and type 0-IIb was significantly less frequent in HGD/CIS lesions (59.5% vs 96.6%, P < .001). The type IV intraepithelial papillary capillary loop pattern was significantly less frequent in HGD/CIS lesions than in LGD lesions (27.0% vs 55.2%, P = .025), and type V-2 was significantly more frequent in HGD/CIS lesions (18.9% vs 0%, P = .015). The en bloc resection rate was 97%. No serious complications occurred. There were no recurrent or metachronous tumors in the 41 patients followed for more than 1 year (median follow-up 27 months). Limitations Retrospective design and single-center study. Conclusions HGD/CIS and LGD differ in various clinical features. ESD appears to be an effective treatment for pharyngeal intraepithelial neoplasias.