Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society

Abstract

Predicting invasion depth of superficial esophageal squamous cell carcinoma is crucial in determining the precise indication for endoscopic resection because the rate of lymph node metastasis increases in proportion to the invasion depth of the carcinoma. Previous studies have shown a close relationship between microvascular patterns observed by Narrow Band Imaging magnifying endoscopy and invasion depth of the superficial carcinoma. Thus, the Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating invasion depth of superficial esophageal squamous cell carcinomas. We conducted a prospective study to evaluate the diagnostic values of type B vessels in the pretreatment estimation of invasion depth of superficial esophageal squamous cell carcinomas utilizing JES classification, the criteria of which are based on the degree of irregularity in the microvascular morphology. Type A microvessels corresponded to noncancerous lesions and lack severe irregularity; type B, to cancerous lesions, and exhibit severe irregularity. Type B vessels were subclassified into B1, B2, and B3, diagnostic criteria for T1a-EP or T1a-LPM, T1a-MM or T1b-SM1, and T1b-SM2 tumors, respectively. We enrolled 211 patients with superficial esophageal squamous cell carcinoma. The overall accuracy of type B microvessels in estimating tumor invasion depth was 90.5 %. We propose that the newly developed JES magnifying endoscopic classification is useful in estimating the invasion depth of superficial esophageal squamous cell carcinoma.

Endoscopic diagnosis and management of early squamous cell carcinoma of esophagus

“…AVA were also classified into small (<0.5 mm), medium 0.5-3 mm), large size (>3 mm), and further incorporated with the IPCL morphological classification in predicting the depth of invasion (Figures 3-6). A prospective multicenter study was reported using this classification (23). The overall accuracy of the system was 90.5%.…”

Narrow-Band Imaging: Clinical Application in Gastrointestinal Endoscopy

“…The advantages of this classification are its easier application and its ability to guide therapy: group 1 lesions require no treatment, group 2 requires careful follow-up or therapy, and group 3 definitely demands therapy. This classification was recently evaluated in a prospective study and an accuracy of 90.5% for the estimation of invasion depth was found [19]. …”

18F‐Fluorodeoxyglucose positron emission tomography can be used to determine the indication for endoscopic resection of superficial esophageal cancer

“…According to the classification established by the Japan Esophageal Society, abnormal microvessels in cancerous lesions were categorized as type B. Type B vessels were subclassified into B1, B2, and B3, which were the diagnostic criteria for T1a‐EP or T1a‐LPM, T1a‐MM or T1b‐SM1, and T1b‐SM2 or deeper tumors, respectively 9. Additionally, EUS was performed using a 20‐MHz catheter probe (UM‐S20‐17S; Olympus) and the water filling method.…”

“…In Japan, the indication for ER of esophageal cancer is a tumor located within the mucosal epithelium (T1a‐EP [equal to Tis in the TNM classification7]) or lamina propria mucosae (T1a‐LPM) because the incidence of lymph node metastasis is very low (≤5%) 8. The recommended diagnostic modalities are endoscopic ultrasonography (EUS)9 and magnifying endoscopy with narrow band imaging (ME‐NBI) 10. However, when these modalities are used, it is sometimes difficult to accurately determine the depth of tumor invasion of superficial esophageal cancer.…”