title: Can flat-type brownish microlesions in the orohypopharynx be followed up without biopsy or endoscopic resection?
abstract: BACKGROUND
  Narrow-band imaging (NBI) is useful for detecting superficial oropharyngeal lesions. However, the diagnostic and treatment guidelines for NBI are not established. The aim of the present study was to evaluate the treatment strategy for these microlesions.
  
  
  METHODS
  From October 2008 to September 2009, 68 flat-type brownish microlesions were observed in the orohypopharynx using NBI. Lesions were examined via magnifying NBI (M-NBI) and followed up without biopsy or endoscopic resection for >12 months. To clarify the characteristics, lesions were compared with the endoscopic characteristics of flat-type lesions diagnosed by biopsy and endoscopic resection as squamous cell carcinoma and high-grade intraepithelial neoplasia.
  
  
  RESULTS
  The average diameter of the 68 lesions was 1.6 mm (range, 0.5-5 mm). At the 1-year follow up, 19 lesions had disappeared. No size increases or morphological changes wereobserved among 49 lesions followed for >1 year. At 2 years, 10 patients had dropped out and 11 lesions had disappeared. No changes were observed among 28 lesions followed for >2 years. Of the flat-type lesions as squamous cell carcinoma and high-grade intraepithelial neoplasia, a distinct border and irregular distribution of atypical vessels were observed in all cases using M-NBI. These findings were observed in two of 68 flat-type brownish microlesions during follow up.
  
  
  CONCLUSIONS
  Although there is some possibility of squamous cell carcinoma or high-grade intraepithelial neoplasia, flat-type microlesions of ≤5 mm diameter in the orohypopharynx may be followed for up to 2 years without biopsy or endoscopic resection.
authors.affiliation: Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Takemura
authors.forename: Hisashi
authors.initials: H
authors.lastname: Doyama
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Nakanishi
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Takeda
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kito
authors.forename: Renma
authors.initials: R
authors.lastname: Ito
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hayashi
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Tsuji
authors.forename: Kei
authors.initials: K
authors.lastname: Tominaga
authors.forename: Naohiro
authors.initials: N
authors.lastname: Yoshida
authors.forename: Yohei
authors.initials: Y
authors.lastname: Waseda
authors.forename: Shigetsugu
authors.initials: S
authors.lastname: Tsuji
authors.forename: Shinya
authors.initials: S
authors.lastname: Yamada
authors.forename: Hideki
authors.initials: H
authors.lastname: Niwa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Katayanagi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kurumaya
authors.forename: Toshihide
authors.initials: T
authors.lastname: Okada
mesh_terms: D000368:Aged; D001706:Biopsy; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062048:Narrow Band Imaging / Q000379:methods*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies
keywords: blood vessel; endoscopy; narrow-band imaging (NBI); pharyngeal cancer; squamous cell carcinoma