Background and Aim. We evaluated the usefulness of background coloration (BC), a color change in the area between intrapapillary capillary loops (IPCLs) in the early esophago-pharyngeal lesions using NBI with magnificaiton. Methods. Between April 2004 and March 2010, a total of 294 esophago-pharyngeal lesions were examined using NBI with magnification, and the presence of BC and IPCL patterns were assessed. Using BC, discrimination of squamous cell carcinoma (SCC) or high-grade neoplasia (HGN) from low-grade neoplasia (LGN) or nonatypia was conducted. Results. Among 294 lesions, 209 lesions (71.1%) were positive for BC, while 85 (28.9%) were negative. In the BC-positive group, 187 lesions (89.5%) were diagnosed as SCC/HGN. And 68 lesions (80.0%) in the BC-negative group were diagnosed as LGN/nonatypia. Overall accuracy of BC to discriminate SCC/HGN from LGN/nonatypia was 87.3%. The sensitivity and specificity were 91.9%, 76.7%. BC could discriminate SCC/HGN from LGN/nonatypia accurately ( ). Among 68 lesions classified into the IPCL type IV, the BC-positive group ( ) included 21 SCC/HGN lesions, while there were 36 LGN/nonatypia lesions in the 42 BC-negative lesions. Conclusions. BC is a useful finding in differentiating SCC/HGN from LGN/nonatypia lesions in the esophagus especially when it is combined with IPCL pattern classification. 1. Introduction The usefulness of narrowband imaging (NBI) magnification in detecting early esophago-pharyngeal lesions including noninvasive high grade neoplasia and invasive squamous cell carcinoma (SCC) has already been reported [1, 2]. Using NBI, such esophago-pharyngeal lesions are recognized as brown-colored area. Magnified endoscopic observation with NBI has been performed to visualize intrapapillary capillary loops (IPCLs) [3–5], the superficial microvascular architecture in the mucosa covered with squamous epithelia. Figure 1 shows IPCL pattern classification, which was introduced by Inoue in 2001. The IPCL pattern is useful in the diagnosis of the depth of tumor invasion for esophago-pharyngeal squamous cell neoplasms. Nevertheless, distinguishing malignant from noncancerous lesions is sometimes difficult even for experienced endoscopists. Figure 1: IPCL pattern classification, which was introduced by Inoue et al. in 2001. Most of IPCL type I to III is corresponding to benign pathology including inflammation and low grade neoplasia (LGN). Approximately 50% of IPCL type IV is corresponding to LGN, and the rest is corresponding to malignant pathology including high grade neoplasia (HGN). IPCL type V is a malignant
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