Masterclass: Advanced GI Endoscopic Imaging (On-Demand) | December 2025-Bechara

Bechara - Optical Diagnosis of Squamous Neoplasia

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This presentation by Dr. Robert Bechara focuses on the assessment and diagnosis of squamous mucosa and neoplasia in the pharyngoesophageal region, emphasizing advanced endoscopic imaging techniques. Key topics include understanding the normal appearance of squamous mucosa, the IPCL (intrapapillary capillary loops) classification system for esophageal squamous neoplasia, and both macroscopic and microscopic evaluation methods.<br /><br />Normal squamous mucosa is characterized for contrast with neoplastic areas, employing image-enhanced endoscopy like Narrow Band Imaging (NBI). The IPCL classification system, introduced by Dr. Inoue and modified by the Japanese Esophageal Society, allows for prediction of invasion depth based on microvascular morphology with a high accuracy (~91%). Morphological changes in microvasculature such as dilatation, tortuosity, and caliber variation are critical in staging.<br /><br />Macroscopic evaluation utilizes the Paris Classification and Lugol's iodine chromoendoscopy. Lugol-voiding lesions indicate potential neoplasia, with sensitivity ranging from 87-100% and variable specificity. The “pink color sign” improves specificity to 95%. The iodine dye technique involves spraying 1% Lugol’s solution with attention to sedation and aspiration prevention.<br /><br />Microscopic assessment focuses on IPCL patterns observed using NBI/BLI techniques to determine lesion depth, guiding therapeutic decisions. Certain IPCL types correlate with mucosal or submucosal invasion, influencing endoscopic resection candidacy and prognosis.<br /><br />Clinical cases illustrate the integration of these techniques. One highlighted case involved a mid-esophageal squamous cell carcinoma with a 1.5 cm lesion showing high-grade dysplasia, diagnosed via endoscopic imaging and Lugol staining. Management was guided by IPCL classification predicting invasion depth, confirmed by pathology revealing well-differentiated carcinoma with submucosal invasion but clear margins.<br /><br />Overall, combining advanced image-enhanced endoscopy with Lugol chromoendoscopy and detailed microvascular pattern analysis provides effective diagnosis and depth staging of esophageal squamous neoplasia, essential for appropriate management and improved patient outcomes.

Keywords

squamous mucosa

pharyngoesophageal region

endoscopic imaging

IPCL classification

esophageal squamous neoplasia

Narrow Band Imaging (NBI)

Lugol's iodine chromoendoscopy

pink color sign

microvascular morphology

depth staging