title: Using typical endoscopic features to diagnose esophageal squamous papilloma.
abstract: OBJECTIVE
  To better understand some of the superficial tiny lesions that are recognized as squamous papilloma of the esophagus (SPE) and receive a different pathological diagnosis.
  
  
  METHODS
  All consecutive patients with esophageal polypoid lesions detected by routine endoscopy at our Endoscopy Centre between October 2009 and June 2014 were retrospectively analysed. We enrolled patients with SPE or other superficial lesions to investigate four key endoscopic appearances (whitish color, exophytic growth, wart-like shape, and surface vessels) and used narrow band imaging (NBI) to distinguish their differences. These series endoscopic images of each patient were retrospectively reviewed by three experienced endoscopists with no prior access to the images. All lesion specimens obtained by forceps biopsy were fixed in formalin and processed for pathological examination. The following data were collected from patient medical records: gender, age, indications for esophagogastroduodenoscopy, and endoscopic characteristics including lesion location, number, color, size, surface morphology, surrounding mucosa, and surface vessels under NBI. Clinicopathological features were also compared.
  
  
  RESULTS
  During the study period, 41 esophageal polypoid lesions from 5698 endoscopic examinations were identified retrospectively. These included 24 patients with pathologically confirmed SPE, 11 patients with squamous hyperplasia, three patients with glycogenic acanthosis, two patients with ectopic sebaceous glands, and one patient with a xanthoma. In the χ (2) test, exophytic growth (P = 0.003), a wart-like shape (P < 0.001), and crossing surface vessels under NBI (P = 0.001) were more frequently observed in SPE than in other lesion types. By contrast, there was no significant difference regarding the appearance of a whitish color between SPE and other lesion types (P = 0.872). The most sensitive characteristic was wart-like projections (81.3%) and the most specific was exophytic growth (87.5%). Promising positive predictive values of 84.2%, 80.8%, and 82.6% were noted for exophytic growth, wart-like projections, and surface vessel crossing on NBI, respectively.
  
  
  CONCLUSIONS
  The use of three key typical endoscopic appearances--exophytic growth, a wart-like shape, and vessel crossing on the lesion surface under NBI--has a promising positive predictive value of 88.2%. This diagnostic triad is useful for the endoscopic diagnosis of SPE.
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Ming-Wun
authors.initials: MW
authors.lastname: Wong
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Ming-Joug
authors.initials: MJ
authors.lastname: Bair
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Shou-Chuan
authors.initials: SC
authors.lastname: Shih
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Cheng-Hsin
authors.initials: CH
authors.lastname: Chu
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Horng-Yuan
authors.initials: HY
authors.lastname: Wang
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Tsang-En
authors.initials: TE
authors.lastname: Wang
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Chen-Wang
authors.initials: CW
authors.lastname: Chang
authors.affiliation: Ming-Wun Wong, Ming-Joug Bair, Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taitung 950, Taiwan.
authors.forename: Ming-Jen
authors.initials: MJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D016009:Chi-Square Distribution; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging; D010212:Papilloma / Q000000981:diagnostic imaging* / Q000473:pathology; D011127:Polyps / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013624:Taiwan
keywords: Diagnosis; Endoscopy; Esophagus; Narrow band imaging; Squamous papilloma