New magnifying endoscopic classification for superficial esophageal squamous cell carcinoma

Abstract

AIMTo assess the accuracy of a new magnifying endoscopy (ME) classification for predicting depth of invasion of superficial esophageal squamous cell carcinoma (SESCC).METHODSThis study included a total of 70 lesions in 69 patients with SESCC who underwent ME with narrow-band imaging (ME-NBI) before resection from August 2010 to July 2016. Accuracy of ME-NBI for predicting depth of invasion of SESCC was analyzed by using a new ME classification proposed by the Japan Esophageal Society (JES), and interobserver agreement was assessed.RESULTSOverall accuracy of ME-NBI for estimating depth of invasion of SESCC was 78.6%. Sensitivity and specificity of type B1 for tumors limited to the epithelial layer (m1) or invading into the lamina propria (m2) were 71.4% and 100%, respectively. Sensitivity and specificity of type B2 for tumors invading into the muscularis mucosa (m3) or superficial submucosa (≤ 200 μm, sm1) were 94.4% and 73.1%, respectively, while those of type B3 for tumors invading into the deep submucosa (> 200 μm, sm2) were 75.0% and 97.8%, respectively. Interobserver agreement was excellent (κ = 0.86, 95%CI: 0.76-0.95).CONCLUSIONThe recently developed JES ME classification is useful for predicting depth of invasion of SESCC, with reliable interobserver agreement.

Histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens in superficial esophageal squamous neoplasms

“…35 Recently, the inter-observer variability has improved following the introduction of a simplified ME classification, as proposed by the Japan Esophageal Society. 33,36 This study had several limitations. First, this was a retrospective study that analyzed the histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens.…”

“…However, chromoendoscopy with iodine staining prolongs the procedure time by 2–5 min and has adverse effects, such as severe chest pain and lung aspiration. Another technique, magnifying endoscopy (ME), especially using narrow‐band imaging, enables the examination of intrapapillary capillary loops (IPCLs) within the esophageal mucosa, which works as an indicator of the histopathologic grade of the SESNs . ME also enables a prediction of the depth of superficial esophageal lesions, based on IPCL pattern changes .…”

“…Another technique, magnifying endoscopy (ME), especially using narrow‐band imaging, enables the examination of intrapapillary capillary loops (IPCLs) within the esophageal mucosa, which works as an indicator of the histopathologic grade of the SESNs . ME also enables a prediction of the depth of superficial esophageal lesions, based on IPCL pattern changes . Therefore, biopsies can be performed that target the portions of the lesions with the most invasive histopathology, based on the observed IPCL patterns.…”

“…However, ME is not available in most hospitals, and the inter‐observer concordance rate is variable due to the complicated diagnostic criteria . Recently, the inter‐observer variability has improved following the introduction of a simplified ME classification, as proposed by the Japan Esophageal Society …”

“…32,33 ME also enables a prediction of the depth of superficial esophageal lesions, based on IPCL pattern changes. 33,34 Therefore, biopsies can be performed that target the portions of the lesions with the most invasive histopathology, based on the observed IPCL patterns. This may also lead to fewer endoscopic biopsies and a decreased risk of histopathologic discrepancies.…”