Maluf-Filho Fauze, Okazaki Ossamu, Nunes Beanie Conceição Medeiros, Safatle-Ribeiro Adriana Vaz, Lenz Luciano, Martins Bruno Costa
Faculdade de Medicina da Universidade de São Paulo, Departamento de Gastroenterologia, São Paulo, SP, Brasil.
Instituto do Câncer, ICESP-HCFMUSP, São Paulo, SP, Brasil.
Arq Gastroenterol. 2025 Sep 5;62:e24120. doi: 10.1590/S0004-2803.24612024-120. eCollection 2025.
Accurate evaluation of the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) is crucial for optimal treatment. While magnifying endoscopy (ME) using the Japanese Esophageal Society (JES) classification is reported as the most accurate method to predict invasion depth, its efficacy has not been tested in the Western world. This study aims to evaluate the interobserver agreement of the JES classification for SESCC and its accuracy in estimating invasion depth in a Brazilian tertiary hospital.
We retrospectively selected ME with Narrow Band Imaging (ME-NBI) images of 30 suspected SESCC cases. The best images of each case were included in online forms, which were evaluated by ten endoscopists (five experts and five novices). The evaluators classified the lesions according to the JES-IPCL classification and estimated the depth of invasion. Interobserver agreement was assessed using kappa values. Histological comparison was possible for 17 lesions.
The overall interobserver agreement for the JES-IPCL classification was moderate (K=0.455, P<0.001). Agreement among experts (K=0.437) and novices (K=0.483) was also moderate. Sensitivity, specificity, and accuracy for IPCL types were: B1 (41.3%, 78.9%, 59.9%), B2 (75%, 66.7%, 68.7%), and B3 (46%, 91.7%, 78.6%). Overall accuracy of the JES classification for estimating depth of invasion was 47.5%.
The moderate interobserver agreement suggests the JES-IPCL classification may be useful in the Western world, but extensive training is needed. The findings indicate a longer learning curve for accurate ME-NBI image evaluation using the JES classification.
准确评估浅表性食管鳞状细胞癌（SESCC）的浸润深度对于优化治疗至关重要。虽然据报道，采用日本食管学会（JES）分类的放大内镜检查（ME）是预测浸润深度最准确的方法，但其有效性尚未在西方世界得到验证。本研究旨在评估JES分类在巴西一家三级医院中对SESCC的观察者间一致性及其在估计浸润深度方面的准确性。
我们回顾性选择了30例疑似SESCC病例的窄带成像放大内镜检查（ME-NBI）图像。将每个病例的最佳图像纳入在线表格，由十名内镜医师（五名专家和五名新手）进行评估。评估者根据JES-IPCL分类对病变进行分类，并估计浸润深度。使用kappa值评估观察者间一致性。对17个病变进行了组织学比较。
JES-IPCL分类的总体观察者间一致性为中等（K = 0.455，P < 0.001）。专家（K = 0.437）和新手（K = 0.483）之间的一致性也为中等。IPCL类型的敏感性、特异性和准确性分别为：B1（41.3%，78.9%，59.9%）、B2（75%，66.7%，68.7%）和B3（46%，91.7%，78.6%）。JES分类估计浸润深度的总体准确性为47.5%。
中等的观察者间一致性表明JES-IPCL分类在西方世界可能有用，但需要进行广泛培训。研究结果表明，使用JES分类进行准确的ME-NBI图像评估需要更长的学习曲线。
