Positive predictive value of the clinical diagnosis of T1a‐epithelial/lamina propria esophageal cancer depends on lesion size. Issue 4 (26th October 2021)

• Record Type: Journal Article
• Authors: Tajiri, Ayaka; Ishihara, Ryu; Sakurai, Hirohisa; Nakamura, Takahiko; Tani, Yasuhiro; Inoue, Takahiro; Matsueda, Katsunori; Miyake, Muneaki; Waki, Kotaro; Fukuda, Hiromu; Shichijo, Satoki; Maekawa, Akira; Kanesaka, Takashi; Yamamoto, Sachiko; Takeuchi, Yoji; Higashino, Koji; Uedo, Noriya; Michida, Tomoki; Kitamura, Masanori; Honma, Keiichiro
• Is Part Of: Digestive endoscopy. Volume 34:Issue 4(2022)
• Page Start: 782
• Page End: 790
• Publication Date: 2021-10-26
• Subjects: accuracy -- endoscopic resection -- EP/LPM -- esophageal squamous cell carcinomas -- size; Digestive organs -- Diseases -- Periodicals; Digestive organs -- Diseases -- Diagnosis -- Periodicals; Endoscopy -- Periodicals; Digestive System Diseases -- diagnosis -- Periodicals; Digestive System Diseases -- therapy -- Periodicals; Endoscopy -- Periodicals; 616.3
• DOI: 10.1111/den.14153
• Languages: English
• ISSNs: 0915-5635

Abstract

Abstract : Objectives: Endoscopic resection (ER) is a minimally invasive treatment for esophageal squamous cell carcinoma (ESCC). However, stricture may develop after ER for widespread lesions. Application of ER is justified if these cancers are pathological T1a‐epithelial/lamina propria (pEP/LPM) cancers that can be cured by ER. We conducted a study to clarify the association between pathological invasion depth and lesion size or circumference in clinical (c) EP/LPM cancers. Methods: From our database, we identified patients diagnosed with cEP/LPM ESCC via endoscopic examination who underwent endoscopic or surgical tumor resection. The accuracy of the cEP/LPM ESCC diagnosis was determined by histologically diagnosing cancer invasion depth as a reference standard. Results: Between January 2015 and December 2019, 1271 cancer patients were diagnosed with cEP/LPM ESCC, of which 1195 (94.0%) were correctly diagnosed with pEP/LPM cancer. The positive predictive value (PPV) classified according to lesion sizes of ≤25, 26–49, and ≥50 mm was 95.8% (981/1024 lesions), 89.7% (191/213 lesions), and 67.6% (23/34 lesions), respectively. PPV according to the circumferential extent of <3/4, ≥3/4, and <1, and whole was 94.6% (1164/1230 lesions), 75.0% (24/32 lesions), and 77.8% (7/9 lesions), respectively. In multivariate analysis, the PPV of cEP/LPM ESCC was significantly associated with lesion size ( P < 0.001) and male sex. Conclusions: Between January 2015 and December 2019, 1271 cancer patients were diagnosed with cEP/LPM ESCC, of which 1195 (94.0%) were correctly diagnosed with pEP/LPM cancer. The PPV of cEP/LPM ESCC was related to lesion size. Treatment should be determined considering the high risk of cancer invasion into the muscularis mucosa or deeper in cEP/LPM cancers with a lesion size of ≥50 mm.