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. 2022 May;34(4):782-790.
doi: 10.1111/den.14153. Epub 2021 Oct 26.

Positive predictive value of the clinical diagnosis of T1a-epithelial/lamina propria esophageal cancer depends on lesion size

Ayaka Tajiri  1 , Ryu Ishihara  1 , Hirohisa Sakurai  1 , Takahiko Nakamura  1 , Yasuhiro Tani  1 , Takahiro Inoue  1 , Katsunori Matsueda  1 , Muneaki Miyake  1 , Kotaro Waki  1 , Hiromu Fukuda  1 , Satoki Shichijo  1 , Akira Maekawa  1 , Takashi Kanesaka  1 , Sachiko Yamamoto  1 , Yoji Takeuchi  1 , Koji Higashino  1 , Noriya Uedo  1 , Tomoki Michida  1 , Masanori Kitamura  2 , Keiichiro Honma  2
Affiliations

Positive predictive value of the clinical diagnosis of T1a-epithelial/lamina propria esophageal cancer depends on lesion size

Ayaka Tajiri et al. Dig Endosc. 2022 May.

Abstract

Objectives: Endoscopic resection (ER) is a minimally invasive treatment for esophageal squamous cell carcinoma (ESCC). However, stricture may develop after ER for widespread lesions. Application of ER is justified if these cancers are pathological T1a-epithelial/lamina propria (pEP/LPM) cancers that can be cured by ER. We conducted a study to clarify the association between pathological invasion depth and lesion size or circumference in clinical (c) EP/LPM cancers.

Methods: From our database, we identified patients diagnosed with cEP/LPM ESCC via endoscopic examination who underwent endoscopic or surgical tumor resection. The accuracy of the cEP/LPM ESCC diagnosis was determined by histologically diagnosing cancer invasion depth as a reference standard.

Results: Between January 2015 and December 2019, 1271 cancer patients were diagnosed with cEP/LPM ESCC, of which 1195 (94.0%) were correctly diagnosed with pEP/LPM cancer. The positive predictive value (PPV) classified according to lesion sizes of ≤25, 26-49, and ≥50 mm was 95.8% (981/1024 lesions), 89.7% (191/213 lesions), and 67.6% (23/34 lesions), respectively. PPV according to the circumferential extent of <3/4, ≥3/4, and <1, and whole was 94.6% (1164/1230 lesions), 75.0% (24/32 lesions), and 77.8% (7/9 lesions), respectively. In multivariate analysis, the PPV of cEP/LPM ESCC was significantly associated with lesion size (P < 0.001) and male sex.

Conclusions: Between January 2015 and December 2019, 1271 cancer patients were diagnosed with cEP/LPM ESCC, of which 1195 (94.0%) were correctly diagnosed with pEP/LPM cancer. The PPV of cEP/LPM ESCC was related to lesion size. Treatment should be determined considering the high risk of cancer invasion into the muscularis mucosa or deeper in cEP/LPM cancers with a lesion size of ≥50 mm.

Keywords: EP/LPM; accuracy; endoscopic resection; esophageal squamous cell carcinomas; size.

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