Department of Gastroenterology, The First Affiliated Hospital of Soochow University, 215006 Suzhou, Jiangsu, China.
Department of Gastroenterology, Kunshan No.5 People Hospital, 215341 Suzhou, Jiangsu, China.
Ann Ital Chir. 2024;95(4):621-627. doi: 10.62713/aic.3528.
The preoperative diagnostic method for superficial esophageal squamous cell carcinoma (SESCC) invasion depth based on the Japan Esophageal Society (JES) classification has been promoted. However, there have been a few investigations into its diagnostic performance in clinical settings. Therefore, we aimed to elucidate the actual diagnostic performance of the JES classification using a single-center retrospective study design.
We retrospectively analyzed the clinical data of 315 newly diagnosed SESCC patients who underwent narrow-band imaging magnifying endoscopy (NBI-ME) examination and received endoscopic submucosal dissection (ESD) or esophagectomy in our center during the past 5 years. To evaluate the diagnostic performance of JES classification in assessing the depth of invasion of SESCC, clinical data of these patients were collected, and the concordance between NBI-ME findings and postoperative pathology reports was analyzed.
This study included a total of 338 lesions. The diagnostic accuracy of vascular morphology was 76.0%. The sensitivity (87.0%) and positive predictive value (PPV, 85.4%) of B1 vessels were high, but the specificity (42.0%) and negative predictive value (NPV, 45.3%) were low. The specificity (86.9% and 98.8%) and NPVs (87.5% and 96.8%) of B2 and B3 vessels were high, but the sensitivity (36.4% and 21.4%) and PPVs (35.1% and 42.9%) ware low. Furthermore, only a few lesions (n = 57) described avascular area, but the overall diagnostic accuracy was not ideal (21.1%). However, if lesions invading the superficial submucosa or shallower were included in the category of "suitable for ESD", the overall accuracy of the JES classification was found to be 95.6%.
In actual clinical settings, the overall accuracy of the JES classification system decreases, but the diagnostic performance of each subtype retains its original characteristics. Additionally, this classification is appropriate for determining whether type 0-II SESCC lesions are suitable for ESD.
基于日本食管协会（JES）分类法，已经提出了一种用于诊断浅表性食管鳞状细胞癌（SESCC）浸润深度的术前诊断方法。然而，在临床环境中对其诊断性能的研究较少。因此，我们旨在通过单中心回顾性研究设计阐明 JES 分类法的实际诊断性能。
我们回顾性分析了过去 5 年在我院接受窄带成像放大内镜（NBI-ME）检查并接受内镜黏膜下剥离术（ESD）或食管切除术的 315 例新诊断 SESCC 患者的临床资料。为了评估 JES 分类法在评估 SESCC 浸润深度方面的诊断性能，收集了这些患者的临床资料，并分析了 NBI-ME 检查结果与术后病理报告之间的一致性。
本研究共纳入 338 处病灶。血管形态的诊断准确性为 76.0%。B1 型血管的敏感性（87.0%）和阳性预测值（85.4%）较高，但特异性（42.0%）和阴性预测值（45.3%）较低。B2 和 B3 型血管的特异性（86.9%和 98.8%）和阴性预测值（87.5%和 96.8%）较高，但敏感性（36.4%和 21.4%）和阳性预测值（35.1%和 42.9%）较低。此外，仅有少数病灶（n=57）描述了无血管区域，但总体诊断准确性不理想（21.1%）。然而，如果将侵犯浅层黏膜或更浅层的病灶归入“适合 ESD”类别，则 JES 分类法的总体准确性发现为 95.6%。
在实际临床环境中，JES 分类系统的总体准确性降低，但各亚型的诊断性能仍保留其原有特征。此外，该分类法适用于确定 0-II 型 SESCC 病变是否适合 ESD。
