目的:推广基于日本食管学会(JES)分类的浅表食管鳞状细胞癌(SESCC)浸润深度的术前诊断方法。然而,对其在临床环境中的诊断性能进行了一些研究。因此,我们旨在使用单中心回顾性研究设计阐明JES分类的实际诊断性能.
方法:我们回顾性分析了315例新诊断的SESCC患者的临床资料,这些患者在过去5年中接受了窄带成像放大内镜(NBI-ME)检查并接受了内镜黏膜下剥离术(ESD)或食管切除术。为了评估JES分类在评估SESCC侵入深度方面的诊断性能,收集这些患者的临床资料,并分析NBI-ME结果与术后病理报告的一致性。
结果:本研究共包含338个病灶。血管形态学诊断准确率为76.0%。敏感性(87.0%)和阳性预测值(PPV,85.4%)的B1血管高,但特异性(42.0%)和阴性预测值(NPV,45.3%)较低。B2和B3血管的特异性(86.9%和98.8%)和NPV(87.5%和96.8%)高,但灵敏度(36.4%和21.4%)和PPV(35.1%和42.9%)偏低。此外,只有少数病变(n=57)描述了无血管区,但总体诊断准确率并不理想(21.1%).然而,如果侵犯浅层粘膜下层或较浅的病变包括在“适合ESD”类别中,JES分类的总体准确率为95.6%.
结论:在实际的临床环境中,JES分类系统的整体精度下降,但是每个亚型的诊断性能都保留了其原始特征。此外,此分类适用于确定0-II型SESCC病变是否适用于ESD.
OBJECTIVE: 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.
METHODS: 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.
RESULTS: 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%.
CONCLUSIONS: 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.