| ObjectivesThe Japan Esophageal Society classification(JES classification)has been widely used to predict the depth of invasion of superficial esophageal squamous cell carcinoma(SESCC).But the diagnostic efficiency of type B2 disappointed us comparing with the high diagnostic efficiency of type B1 and B3.This study purposed to prominently enhance the correct rate of type B2 diagnosis by analyzing the risk factors of preoperative misdiagnosis of the depth of infiltration.MethodsWe included a total of 210 SESCCs who had complete pathological data and MENBI data from the digestive endoscopy center of the Sanjia Hospital from January 2015 to December 2020.The morphology of the Intraepithelial papillary capillary loop(IPCL)was recorded according to the JES Classification.There were 105 cases(105 lesions)of type B2 vessels observed by ME-NBI,and the treatment(endoscopic resection or surgical treatment)was determined according to the preoperative examination.All cases were histologically reviewed by experienced pathologists and classified into the correct diagnosis group(p MM/SM1,29 lesions),the overdiagnosis group(p EP/LPM,64 lesions),and the underdiagnosis group(p SM2-3,12 lesions).We estimated the largest diameter of the area with type B2.Our study made use of the χ2 test to compare the difference in the largest diameter of the area with type B2 between the three groups and we utilized the logistic regression analysis to inspect the factors relating to invasion depth diagnosis.ResultsA total of 280 patients with SESCC(280 lesions)were diagnosed by endoscopy before the operation,including 168 cases of B1,105 cases of B2,and 7 cases of B3.The overall accuracy of JES classification is 64.64%.In type B1,the accuracy,sensitivity,specificity of EP and LPM was 88.10%,68.84%,69.23%;In type B2,the accuracy,sensitivity,specificity of MM and SM1 was 27.62%,64.44%,67.66%;In type B3,the accuracy,sensitivity,specificity of SM2-3 was 57.14%,20.00%,98.85%,respectively.105 cases with B2 were included,with 69 males and 36 females,the median age of61 years,the median size of lesions of 40 mm.78 lesions were resected with endoscopy,and 27 lesions were treated with surgery.The morphological manifestations were mainly typed IIb(77.1%,81/105).According to postoperative pathology,the 105 SESCCs lesions were divided into the correct diagnosis group(p MM/SM1,29 lesions),the overdiagnosis group(p EP/LPM,64 lesions),and the underdiagnosis group(p SM2-3,12lesions).A distinct difference exists in the largest diameter of the area with type B2 among the three groups(P < 0.05).The sensitivity,specificity,positive predictive value,and negative predictive value of B2-broad(diameter of the area with B2 vessels>5 mm)were70.73%,95.31%,90.63%and83.56%,respectively.B2-narrow(diameter of the area with B2 vessels≤5mm),no significant features under endoscopy and inflammatory erosion around type B2 were distinctly related to overdiagnosis,while significant features under endoscopy were notably related to underdiagnosis.After rectifying these influencing factors,the positive predictive value of type B2 was remarkably increased from 27.62%to 61.70%(P<0.01).ConclusionsCombining assessment of the regional diameter and endoscopic findings with type B2,the correct rate of type B2 diagnosis can be incredibly promoted.B2-narrow,no significant characteristics under endoscopy,and inflammatory erosion around B2 vessels tend to be diagnosed as T1a-EP/LPM,while endoscopic features are associated with the insufficient diagnosis. |
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