Objective: To investigate the diagnostic value of white substance in the detection of flat esophageal mucosal lesions and precancerous lesions associated with early esophageal squamous cell carcinoma
Methods: Clinical and pathological data of patients diagnosed with flat esophageal mucosal disease were collected. The lesions were divided into a neoplastic group and a non-neoplastic group, and the clinicopathological differences between the groups were analyzed. The patients were also divided into two groups based on the presence of white substance after endoscopic examination: a “white substance” group and a “non-white substance” group. The differences between the two groups were analyzed. The diagnostic value of white substance for detection of early esophageal squamous cell carcinoma and related precancerous lesions was calculated and the pathological nature of white substance inferred.
Results: In total, 183 patients with flat esophageal mucosal lesions were enrolled, including 92 (50.3%) with neoplastic lesions and 91 (49.7%) with non-neoplastic lesions. Forty-nine cases (26.8%) presented white substance in the esophageal mucosa. White substance was mainly found in female patients (57.1%), middle esophagus (75.5%), and 60-69-year-old patients (51.0%). Moreover, white substance was more frequently found in neoplastic than in non-neoplastic lesions (43.5% vs. 11.0%, p < 0.05). Consistently, neoplastic lesions were more represented in the white substance group than in the non-white substance group and the difference was statistically significant (79.6 vs. 20.4%, p < 0.05). 51% of the patients in the white substance group, but only 26.1% of those in the non-white substance group, had hyperkeratosis and necrosis, and the difference was statistically significant (p < 0.05). The diagnostic sensitivity of white substance for detection of early esophageal squamous cell carcinoma and precancerous lesions was 42.4% (95% CI, 32.8%–52.6%),the specificity 89.0% (95% CI, 80.8%–94.1%).
Conclusions: White substance in the mucosa of flat esophageal lesions exhibited high specificity for the diagnosis of early esophageal squamous cell carcinoma and precancerous lesions. Thus, the presence of white substance in the esophageal mucosa, even in the absence of obvious lesions, may reflect the presence of latent early esophageal squamous cell carcinoma and precancerous lesions. White substance was associated with hyperkeratosis and necrosis.