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A prospective multicenter study of the magnifying endoscopic evaluation of the invasion depth of superficial esophageal cancers

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Abstract

Background

Treatment strategies for superficial esophageal squamous cell carcinoma (SESCC) are determined mainly on the basis of the invasion depth. The Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating the invasion depth of SESCC. We aimed to evaluate its accuracy.

Methods

We prospectively applied the JES classification for estimating the invasion depth of SESCC to 204 consecutive lesions from 6 hospitals in Japan between April 2016 and October 2018. We analyzed the accuracy of the endoscopic diagnosis by adding the following two categories to the JES classification: ≥ 7 mm lesion in B2 vessels (defined as B2 ≥ 7 mm) and B2 vessels with inflammation (defined as B2i).

Results

After applying the exclusion criteria, 201 lesions remained in the analysis. The diagnostic value of type B1, B2, B3 vessels were as follows: sensitivity, 93.9%, 68.0%, 25.0%; specificity, 81.1%, 89.2%, 99.4%; positive predictive value (PPV), 95.6%, 47.2%, 75.0%; negative predictive value (NPV), 75.0%, 95.1%, 95.4%; and accuracy, 91.5%, 86.5%, 95.0%, respectively. A retrospective analysis showed that the diagnostic accuracy was higher in type B2 vessels (86.5% to 92.0%). An avascular area (AVA) was found in 55 (27%) of the 201 lesions, which tended to be associated with a deeper pathological diagnosis of each Type B vessel. In an additional analysis, B2 ≥ 7 mm and B2i improved the diagnostic accuracy of type B2 vessels from 86.5% to 92.0%.

Conclusions

The JES classification is useful for estimating the invasion depth of SESCC. The diagnostic accuracy for type B2 vessels was low, which may be improved by using B2 ≥ 7 mm and B2i.

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Abbreviations

ESD:

Endoscopic submucosal dissection

SESCC:

Superficial esophageal squamous cell carcinoma

JES:

Japan Esophageal Society

NBI:

Narrow band imaging

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Acknowledgements

We thank Dr. Yuki Morito, Dr. Koji Miyahara (Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital), Dr. Isao Fujita (Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center), and Dr.Yuki Okamoto, Dr. Yuka Obayasi, Dr. Yuki Baba, Dr. Kenta Hamada, Dr. Hiroyuki Sakae (Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences) for providing the baseline data and their helpful discussions. The authors acknowledge the help of our endoscopy nurses, endoscopy technicians, and medical assistants.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata, Okayama, 700-8558, Japan

    Tatsuhiro Gotoda, Keisuke Hori, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Seiji Kawano & Hiroyuki Okada

  2. Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, 7-33 Motomachi, Naka-Ku, Hiroshima, 730-8518, Japan

    Masahiro Nakagawa

  3. Department of Internal Medicine, Hiroshima City Fukuyama Citizens Hospital, 5-23-1 Zao-cho, Fukuyama, Hiroshima, 721-0971, Japan

    Sayo Kobayashi

  4. Department of Gastroenterology, National Hospital Organization Fukuyama Medical Center, 4-14-17 Okinogami-cho, Fukuyama, Hiroshima, 720-0825, Japan

    Tatsuya Toyokawa

  5. Department of Internal Medicine, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Kita-Ku, Okayama, 700-8511, Japan

    Shuhei Ishiyama

  6. Department of Gastroenterology, Mitoyo General Hospital, 708 Himehama, Kanonji, Kagawa, 769-1695, Japan

    Atsushi Imagawa

  7. Department of Endoscopy, Okayama University Hospital, 2-5-1 Shikata, Okayama, 700-8558, Japan

    Yoshiro Kawahara & Hiroyuki Okada

Authors
  1. Tatsuhiro Gotoda
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  2. Keisuke Hori
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  3. Masahiro Nakagawa
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  8. Makoto Abe
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  13. Yoshiro Kawahara
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  14. Hiroyuki Okada
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Contributions

TG and KH: contributed to study design, drafting, data analysis, interpretation and manuscript writing. MN, SK, TT, SI, AI, and YK: contributed to data collection and interpretention. Hiroyuki Okada gave final approval of the manuscript. All authors contributed to the revision of the manuscript.

Corresponding author

Correspondence to Hiroyuki Okada.

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Disclosures

Tatsuhiro Gotoda, Keisuke Hori, Masahiro Nakagawa, Sayo Kobayashi, Tatsuya Toyokawa, Shuhei Ishiyama, Atsushi Imagawa, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara and Hiroyuki Okada declare that they have no conflicts of interest or financial ties to disclose.

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Gotoda, T., Hori, K., Nakagawa, M. et al. A prospective multicenter study of the magnifying endoscopic evaluation of the invasion depth of superficial esophageal cancers. Surg Endosc 36, 3451–3459 (2022). https://doi.org/10.1007/s00464-021-08666-w

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  • DOI: https://doi.org/10.1007/s00464-021-08666-w

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