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Novel Endoscopic Criteria for Predicting Tumor Invasion Depth in Superficial Esophageal Squamous Carcinoma

Journal of Korean Medical Science 2020년 35권 41호 p.336 ~ 336
최지영, 배서은, 안지용, 이정훈, 박영수, 김도훈, 최기돈, 장혜숙, 송호준, 이진혁, 최재원, 장세진, 정훈용,
소속 상세정보
최지영 ( Choi Ji-Young ) - University of Ulsan College of Medicine Asan Medical Center Health Promotion Center
배서은 ( Bae Suh-Eun ) - University of Ulsan College of Medicine Asan Medical Center Health Promotion Center
안지용 ( Ahn Ji-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
이정훈 ( Lee Jeong-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
박영수 ( Park Young-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
김도훈 ( Kim Do-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
최기돈 ( Choi Kee-Don ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
장혜숙 ( Chang Hye-Sook ) - University of Ulsan College of Medicine Asan Medical Center Health Promotion Center
송호준 ( Song Ho-June ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
이진혁 ( Lee Gin-Hyug ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
최재원 ( Choe Jae-won ) - University of Ulsan College of Medicine Asan Medical Center Health Promotion Center
장세진 ( Jang Se-Jin ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
정훈용 ( Jung Hwoon-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology

Abstract


Background: Accurate prediction of tumor invasion depth in superficial esophageal squamous carcinoma (SESC) is essential for deciding the appropriate treatment strategy. We proposed novel endoscopic criteria to differentiate between mucosal and submucosal esophageal cancers and to evaluate the diagnostic accuracy and usefulness of the criteria.

Methods: A total of 352 patients who underwent endoscopic or surgical resection for SESC between 1991 and 2010 were included. First, the novel endoscopic criteria were created based on the endoscopic features of 60 randomly selected patients as follows: for T1m cancers, I. flat or slightly elevated or depressed lesion with smooth/even surface of any size, II. slightly elevated lesion of ≤ 1 cm with granular or uneven surface, III. hyperemic flat lesion of ≤ 3 cm with granular or uneven surface, IV. slightly depressed lesion of ≤ 2 cm with uneven surface and for T1sm cancers, I. irregularly (unevenly) nodular or protruded lesion of any size, II. slightly elevated lesion of > 1 cm with granular or uneven surface, III. hyperemic flat lesion of > 3 cm with granular or uneven surface, IV. irregularly (unevenly) depressed lesion of > 2 cm, and V. ulcerative lesion of any size. Next, the endoscopic findings of the remaining 292 patients were reviewed according to the criteria.

Results: The accuracy of novel endoscopic criteria was 79.5% (232/292). The sensitivity and specificity of mucosal cancers were 78.4% and 81.0%, respectively, whereas those for submucosal cancers were 81.0% and 78.4%, respectively. The accuracy for mucosal cancers was high (97.3%, 72/74) when the lesions were flat or slightly elevated/depressed with smooth/even surface regardless of size, whereas that for submucosal cancers was high (85.7%, 18/21) when the lesions were irregular/nodular protrusions regardless of size. In multivariate analysis, macroscopic type IIb lesion was identified as an independent factor affecting accuracy (P < 0.05). The difference in recurrence-free survival rates between endoscopically mucosal and submucosal cancers was significant (P = 0.026).

Conclusion: The novel endoscopic criteria appear to be accurate and useful in predicting invasion depth in SESC. Our criteria might help not only to decide the treatment strategy between surgery and endoscopic resection but also to predict the outcomes of SESC.

키워드

Esophageal Neoplasms; Endoscopy; Neoplasm Staging; Prognosis

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