Endoscopic ultrasound using ultrasound probes for the diagnosis of early esophageal and gastric cancers

Figure 1 Scheme of the depth of esophageal cancer invasion.

Figure 2 Differences in endoscopic ultrasound features with quality of water used for irrigation. A: Water from a faucet ; B: Deaerated water.

Figure 3 Endoscopic ultrasound procedure for early esophageal cancer as performed at the National Cancer Center Hospital. A: Endoscopic features after washing mucus and saliva from the lesion; B: Endoscopic features after region is filled with deaerated water. Endoscopic ultrasound (EUS) can be performed under direct vision of the lesion; C: EUS features.

Figure 4 Endoscopic ultrasound features of normal esophageal wall. Each numbered circle, 1-9, with a white arrow, indicates the corresponding numbered tissue layer, first through ninth.

Figure 5 Findings for an m1 cancer of the esophagus. A: Endoscopic features. A reddish depressed lesion was located on the anterior and left wall of the middle esophagus; B: Endoscopic features after iodine dye. Biopsy specimens showed squamous cell carcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed an irregularity of the first layer and a slight thickness of the second layer; D: Pathological findings. The tumor was confined to the epithelium. (Hematoxylin and eosin stain, × 40).

Figure 6 Findings for an m2 cancer of the esophagus. A: Endoscopic features. A reddish flat lesion was located on the anterior wall of the middle esophagus; B: Endoscopic features after iodine dye. Biopsy specimens showed squamous cell carcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed a thickness in the second layer and a disappearance of the third layer. The yellow line with an arrow indicates the intact fourth layer; D: Pathological findings. The tumor was confined to the lamina propria. (Hematoxylin and eosin stain, × 100).

Figure 7 Findings for an m3 cancer of the esophagus. A: Endoscopic features. A reddish flat and partially elevated lesion was located on the posterior wall of the middle esophagus; B: Endoscopic features after iodine dye. Biopsy specimens showed squamous cell carcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed a thickness of the second layer and a disappearance of the third and fourth layer. The fifth layer seemed to be intact; D: Pathological findings. The tumor was reaching and partially invading the muscularis mucosae. (Hematoxylin and eosin stain, × 40).

Figure 8 Findings for an sm1 cancer of the esophagus. A: Endoscopic features. A depressed, white, flat lesion was located on the posterior wall of the middle esophagus; B: Endoscopic features after iodine dye. Biopsy specimens showed squamous cell carcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed a thickness of the second layer and a disappearance of the third and fourth layer. The fifth layer seemed to be slightly irregular; D: The tumor was invading the submucosal layer to about 170 μm in depth. (Hematoxylin and eosin stain, × 40).

Figure 9 Findings for an sm2 cancer of the esophagus. A: Endoscopic features. A depressed lesion was located on the posterior and right wall of the middle esophagus; B: Endoscopic features after iodine dye. Biopsy specimens showed squamous cell carcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed a thickness of the second layer and a disappearance of the third and fourth layer. The fifth layer had become thin, but the sixth layer was intact; D: Pathological findings. The tumor was invading the submucosal layer to a 320 μm depth. (Hematoxylin and eosin stain, × 40).

Figure 10 Endoscopic ultrasound procedure as performed at the National Cancer Center Hospital when it is difficult to approach lesions horizontally. A: Elevated lesion with central depression was located on the greater curvature of the angle; B: The lesion could be approached horizontally when using a multi-bending endoscope; C: Endoscopic ultrasound features after region is filled with deaerated water.

Figure 11 Endoscopic ultrasound features of normal gastric wall. Each numbered circle, 1-5, with a white arrow, indicates the corresponding numbered tissue layer, first through fifth.

Figure 12 Findings for an m cancer of the stomach. A: Endoscopic features. A depressed lesion with surrounding elevation was located on the greater curvature of the antrum; B: Endoscopic figure after indigo carmine dye. Biopsy specimens showed adenocarcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed an irregularity of the first layer and a slight thickness of the second layer; D: Pathological findings. The tumor was confined to the lamina propria. (Hematoxylin and eosin stain, × 40).

Figure 13 Findings for an sm2 cancer of the stomach. A: Endoscopic features. An elevated lesion was located on the posterior wall of the upper gastric body; B: Endoscopic features after indigo carmine dye. Biopsy specimens showed adenocarcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed a thickness of the second layer and a thin third layer, but the fourth layer was intact; D: Pathological findings. The tumor was invading the submucosa massively. (Hematoxylin and eosin stain, × 12.5).

Figure 14 Findings for an sm1 cancer of the stomach. A: Endoscopic features. A white, flat lesion with central elevation was located on the greater curvature of the angle; B: Endoscopic features after indigo carmine dye. Biopsy specimens showed adenocarcinoma; C: Endoscopic ultrasound (EUS) features. The white dotted line indicates the extent of the lesion. EUS revealed a thickness of the second layer and a slightly irregular third layer; D: Pathological findings. The tumor was invading the submucosal layer to a 400 μm depth. (Hematoxylin and eosin stain, × 40).