Department of, Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan.
Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan.
Dig Endosc. 2022 May;34(4):782-790. doi: 10.1111/den.14153. Epub 2021 Oct 26.
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.
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.
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.
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.
内镜下切除（ER）是治疗食管鳞状细胞癌（ESCC）的一种微创方法。然而，对于广泛病变，ER 后可能会发生狭窄。如果这些癌症是可以通过 ER 治愈的病理 T1a-上皮/固有层（pEP/LPM）癌症，则可以应用 ER。我们进行了一项研究，以阐明临床（c）EP/LPM 癌症中病理浸润深度与病变大小或周长之间的关系。
从我们的数据库中，我们确定了通过内镜检查诊断为 cEP/LPM ESCC 并接受内镜或手术肿瘤切除术的患者。通过将组织学诊断的癌症浸润深度作为参考标准，确定 cEP/LPM ESCC 诊断的准确性。
2015 年 1 月至 2019 年 12 月期间，1271 例癌症患者被诊断为 cEP/LPM ESCC，其中 1195 例（94.0%）被正确诊断为 pEP/LPM 癌症。根据病变大小≤25、26-49 和≥50mm 进行分类的阳性预测值（PPV）分别为 95.8%（981/1024 个病变）、89.7%（191/213 个病变）和 67.6%（23/34 个病变）。根据<3/4、≥3/4、<1 和整个周径范围进行分类的 PPV 分别为 94.6%（1164/1230 个病变）、75.0%（24/32 个病变）和 77.8%（7/9 个病变）。多变量分析显示，cEP/LPM ESCC 的 PPV 与病变大小（P<0.001）和男性性别显著相关。
2015 年 1 月至 2019 年 12 月期间，1271 例癌症患者被诊断为 cEP/LPM ESCC，其中 1195 例（94.0%）被正确诊断为 pEP/LPM 癌症。cEP/LPM ESCC 的 PPV 与病变大小有关。对于病变大小≥50mm 的 cEP/LPM 癌症，应考虑癌症侵犯黏膜肌层或更深层的高风险，从而确定治疗方案。
