Department of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
United European Gastroenterol J. 2024 Oct;12(8):1069-1080. doi: 10.1002/ueg2.12601. Epub 2024 Jun 20.
The Japan Esophageal Society proposed the JES microvessel classification to assess eligibility of early esophageal squamous cell neoplasia (ESCN) for endoscopic resection based on intrapapillary capillary loop assessment. We aimed to assess its diagnostic reproducibility and accuracy in Western ESCN patients.
Intrapapillary capillary loops on endoscopic images of Western ESCN lesions (n = 113) collected between 2010 and 2022 were assessed by nine endoscopists, including three Japanese expert endoscopists, three Western expert endoscopists, and three residents-in-training, and graded according to the JES microvessel classification where microvessel type A corresponds with normality or low-grade intraepithelial neoplasia, and microvessel types B1, B2, and B3 correspond with high-grade intraepithelial neoplasia or invasion into the lamina propria, muscularis mucosae or superficial submucosa, and deep submucosa, respectively. Outcomes included overall accuracy in predicting ESCN invasion depth and interobserver agreement.
Good interobserver agreement was observed among expert endoscopists (Krippendorf's alpha 0.64, 95% CI 0.57-0.70), while agreement was moderate among residents-in-training (Krippendorf's alpha 0.58, 95% CI 0.52-0.72). Overall accuracy of the JES microvessel classification was 53% (95% CI 42-63), 52% (95% CI 41-62), and 44% (95% CI 34-55) for Japanese endoscopists, Western endoscopists, and residents-in-training, respectively. Sensitivity and specificity for vessel type A, B1, B2, and B3 across assessors were 0%-50% and 89%-100%, 55%-64% and 66%-77%, 42%-71% and 60%-76%, and 10%-24% and 92%-97%, respectively. Negative predictive value ranged between 80% and 85% for B3 vessels.
Overall accuracy of the JES microvessel classification in Western ESCN patients is low, though absence of B3 vessels as assessed by experienced endoscopists may predict superficial ESCN amenable to endoscopic resection.
www.trialregister.nl; NL8897 (6-9-2020).
日本食管学会提出了 JES 微血管分类，以根据乳头内毛细血管环评估对早期食管鳞状细胞肿瘤（ESCN）进行内镜切除的适应证。我们旨在评估其在西方 ESCN 患者中的诊断可重复性和准确性。
收集 2010 年至 2022 年间的西方 ESCN 病变内镜图像中的乳头内毛细血管环（n=113），由 9 名内镜医师进行评估，包括 3 名日本专家内镜医师、3 名西方专家内镜医师和 3 名受训住院医师，并根据 JES 微血管分类进行分级，其中微血管类型 A 对应于正常或低级别上皮内肿瘤，微血管类型 B1、B2 和 B3 分别对应于高级别上皮内肿瘤或侵犯固有层、黏膜肌层或黏膜浅层和黏膜深层。结果包括预测 ESCN 浸润深度的整体准确性和观察者间一致性。
专家内镜医师之间观察到良好的观察者间一致性（Krippendorf's alpha 0.64，95%CI 0.57-0.70），而受训住院医师之间的一致性为中度（Krippendorf's alpha 0.58，95%CI 0.52-0.72）。日本内镜医师、西方内镜医师和受训住院医师的 JES 微血管分类的总体准确性分别为 53%（95%CI 42-63）、52%（95%CI 41-62）和 44%（95%CI 34-55）。评估者的血管类型 A、B1、B2 和 B3 的灵敏度和特异性分别为 0%-50%和 89%-100%、55%-64%和 66%-77%、42%-71%和 60%-76%以及 10%-24%和 92%-97%。B3 血管的阴性预测值在 80%-85%之间。
西方 ESCN 患者 JES 微血管分类的总体准确性较低，尽管经验丰富的内镜医师评估不存在 B3 血管可能预测浅表 ESCN 适合内镜切除。
www.trialregister.nl；NL8897（2020 年 9 月 6 日）。
