Abstract
A pre-operative accurate estimation of a proximal border of the infiltration from an esoph-ageal carcinoma is essential for the decision of the range of resection and the field to be irradiated. The autor studied esophagoscopically the mode of infiltration of an esophageal carcinoma to the oral side and classified the findings into a small elevation, a fold-like elevation, an erosion and flat changes which includes all the other superficial changes. These esophagoscopic findings were histologically evaluated and clarified their nature. Many supplementary studies were made for the purspose of detecting submucosal malignant infiltration, by means of a dye sprinkling method, a magnified esophagoscope with 25 times magnification (FES-ML), a thorny needle biopsy and a cytologic examination. Sprinkling of a blue dye was useful in the fine observation of a reddening or a small elevation by giving a contrast, and it also made the margin of erosions clearer by staining the white fur. A sprinkling of Lugol's solution resulted in an easier identification of the intra-epithelial infiltration. A magnified esophagoscopic observation was effective for the diagnosis of an exposed cancer or a subepithelial malignant infiltraion by detecting the disappearance of normal capillary network. It was also effective for the differential diagnosis of benign or malignant erosions and small elevations. A thorny needle biopsy was effective for the diagnosis of subepithelial infiltration for reasons of accuracy of aiming and enough amount of collected cells. When a proximal border of the malignant infiltration was estimated by using those methods, radio-opaque clips were placed to show it, for the purpose of helping a surgical intervention or irradiation.
