Diagnostic Efficacy of Type B Vessels in the Japan Esophageal Society Classification for the Depth of Invasion of Superficial Esophageal Squamous Cell Carcinoma

Abstract

AIM: 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.