Shigeto Yoshida

Bio: Shigeto Yoshida is an academic researcher from Hiroshima University. The author has contributed to research in topics: Endoscopic mucosal resection & Early Gastric Cancer. The author has an hindex of 39, co-authored 107 publications receiving 7238 citations.

The Paris endoscopic classification of superficial neoplastic lesions : esophagus, stomach and colon.

Abstract: An international group of endoscopists, surgeons, and pathologists gathered in Paris for an intensive workshop designed to explore the utility and clinical relevance of the Japanese endoscopic classification of superficial neoplastic lesions of the GI tract. This report summarizes the conclusions of the workshop and proposes a general framework for the endoscopic classification of superficial lesions of the esophagus, stomach, and colon. The clinical relevance of this classification is demonstrated in tables that show the relative proportion of each subtype in the esophagus, stomach, and colon, assessing the risk of submucosal invasion and the risk of lymph node metastases. In the esophagus, stomach, and colon, neoplastic lesions of the digestive tract are called ‘‘superficial’’ at endoscopy when the endoscopic appearance suggests either a small cancer or a noninvasive neoplastic lesion (dysplasia/adenoma). If invasive, ‘‘superficial’’ tumors correspond to the T1 stage of the TNM classification, in which invasion is limited to the mucosa and submucosa. ‘‘Superficial’’ tumors are nonobstructive, usually are asymptomatic, and often are detected as an incidental finding or by screening. In Japan, neoplastic lesions of the stomach with a ‘‘superficial’’ endoscopic appearance are classified as subtypes of ‘‘type 0.’’ The term ‘‘type 0’’ was chosen to distinguish the classification of ‘‘superficial’’ lesions from the Borrmann classification, proposed in 1926 for ‘‘advanced’’ gastric tumors, which included types 1 to 4. Within type 0, there are polypoid and non-polypoid subtypes. The nonpolypoid subtypes include lesions with a small variation of the surface (slightly elevated, flat, and slightly depressed) and excavated lesions. The Japanese Gastric Cancer Association (JGCA) also added a type 5 for unclassifiable advanced tumors. The complete modification for gastric tumors becomes:

Update on the Paris classification of superficial neoplastic lesions in the digestive tract

Abstract: Background and Study Aims: Neoplastic lesions in the digestive-tract mucosa are termed superficial when the depth of invasion is limited to the mucosa and submucosa. The endoscopic appearance has a predictive value for invasion into the submucosa, which is critical for the risk of nodal metastases. Materials and Methods: The endoscopic morphology of superficial lesions can be assessed with a standard video endoscope after spraying of a dye - an iodine-potassium iodide solution for the stratified squamous epithelium, or an indigo carmine solution for the columnar epithelium. In 2002, a workshop was held in Paris to explore the relevance of the Japanese classification. The conclusions were revised in 2003 in Osaka in relation to the definition of the subtypes used in endoscopy and the evaluation of the depth of invasion into the submucosa. In Japan, the description of advanced cancer in the digestive-tract mucosa using types 1 -4 is supplemented by a type 0 when the endoscopic appearance is that of a superficial lesion. Type 0 is divided into three categories: protruding (0-1), nonprotruding and nonexcavated (0-11), and excavated (0-III). Type 0-II lesions are then subdivided into slightly elevated (IIa), flat (IIb), or depressed (IIc). Nonprotruding depressed lesions are associated with a higher risk of submucosal invasion. After endoscopic resection, invasion into the submucosa is an important criterion for the necessity of additional surgical resection. Micrometer analysis of the depth of invasion in the specimen is more precise, and distinct cut-off limits have been established in the esophagus, stomach, and large bowel. Conclusions: The morphology of superficial and nonprotruding neoplastic lesions is relevant to the prognosis. Following endoscopic detection, the lesions are analyzed using chromoendoscopy and assigned a subtype of the type 0 classification. The choice between endoscopicorsurgical treatment is based on this description.

Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study.

Abstract: BACKGROUND AND STUDY AIMS A newly developed narrow-band imaging (NBI) technique, in which modified optical filters were used in the light source of a video endoscope system, was applied during colonoscopy in a clinical setting. This pilot study evaluated the clinical feasibility of the NBI system for evaluating colorectal lesions. PATIENTS AND METHODS A total of 43 colorectal lesions in 34 patients were included in the study. The quality of visualization of colorectal lesions and the accuracy of differentiation between neoplastic and non-neoplastic lesions using the NBI system were evaluated in comparison with results from conventional colonoscopy and with chromoendoscopy. RESULTS For pit pattern delineation, NBI was superior to conventional endoscopy (P < 0.001), but inferior to chromoendoscopy (P < 0.05). NBI achieved better visualization of the mucosal vascular network and of the hue of lesions than conventional endoscopy (P < 0.05). However there was no significant difference between NBI and chromoendoscopy in differentiating neoplastic from non-neoplastic lesions (both techniques had a sensitivity of 100 % and a specificity 75 %). This was better than the results of conventional colonoscopy (sensitivity 83 %, specificity 44 %; P < 0.05 for specificity). CONCLUSIONS These results suggest that in the examination of colonic lesions the NBI system provides imaging features additional to those of both conventional endoscopy and chromoendoscopy. For distinguishing neoplasms from non-neoplastic lesions, NBI was equivalent to chromoendoscopy.

The Paris endoscopic classification of superficial neoplastic lesions : esophagus, stomach and colon.

Abstract: An international group of endoscopists, surgeons, and pathologists gathered in Paris for an intensive workshop designed to explore the utility and clinical relevance of the Japanese endoscopic classification of superficial neoplastic lesions of the GI tract. This report summarizes the conclusions of the workshop and proposes a general framework for the endoscopic classification of superficial lesions of the esophagus, stomach, and colon. The clinical relevance of this classification is demonstrated in tables that show the relative proportion of each subtype in the esophagus, stomach, and colon, assessing the risk of submucosal invasion and the risk of lymph node metastases. In the esophagus, stomach, and colon, neoplastic lesions of the digestive tract are called ‘‘superficial’’ at endoscopy when the endoscopic appearance suggests either a small cancer or a noninvasive neoplastic lesion (dysplasia/adenoma). If invasive, ‘‘superficial’’ tumors correspond to the T1 stage of the TNM classification, in which invasion is limited to the mucosa and submucosa. ‘‘Superficial’’ tumors are nonobstructive, usually are asymptomatic, and often are detected as an incidental finding or by screening. In Japan, neoplastic lesions of the stomach with a ‘‘superficial’’ endoscopic appearance are classified as subtypes of ‘‘type 0.’’ The term ‘‘type 0’’ was chosen to distinguish the classification of ‘‘superficial’’ lesions from the Borrmann classification, proposed in 1926 for ‘‘advanced’’ gastric tumors, which included types 1 to 4. Within type 0, there are polypoid and non-polypoid subtypes. The nonpolypoid subtypes include lesions with a small variation of the surface (slightly elevated, flat, and slightly depressed) and excavated lesions. The Japanese Gastric Cancer Association (JGCA) also added a type 5 for unclassifiable advanced tumors. The complete modification for gastric tumors becomes: