Macroscopic estimation of submucosal invasion in the esophagus

In esophageal squamous cell carcinoma, the depth of invasion into the wall is closely associated with metastasis to lymph nodes. Esophageal cancer invading the muscularis mucosae could be curably treated by endoscopic submucosal dissection but cancer with submucosal invasion necessitates surgical resection and/or chemoradiotherapy. Therefore, pretreatment diagnosis of invasion depth is crucially important for selecting appropriate treatment strategies for each individual patient. To estimate the depth of cancer invasion for early squamous cell carcinoma of the esophagus, standard endoscopy with image enhancement and endoscopic ultrasound are currently considered the best methods.