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Esophagus. 2017;14(2):105-112. doi: 10.1007/s10388-016-0527-7. Epub 2016 Apr 6.

Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society.

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Department of Endoscopy, Saku Central Hospital Advanced Care Center, Nagano, Japan.
Digestive Disease Center, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan.
Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
Center for Diagnostic and Therapeutic Endoscopy, Keio University, Tokyo, Japan.
Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Department of Gastroenterology, Sendai City Medical Center, Miyagi, Japan.
Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Department of Gastroenterology, Saku Central Hospital Advanced Care Center, Nagano, Japan.
Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461 Japan.


Predicting invasion depth of superficial esophageal squamous cell carcinoma is crucial in determining the precise indication for endoscopic resection because the rate of lymph node metastasis increases in proportion to the invasion depth of the carcinoma. Previous studies have shown a close relationship between microvascular patterns observed by Narrow Band Imaging magnifying endoscopy and invasion depth of the superficial carcinoma. Thus, the Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating invasion depth of superficial esophageal squamous cell carcinomas. We conducted a prospective study to evaluate the diagnostic values of type B vessels in the pretreatment estimation of invasion depth of superficial esophageal squamous cell carcinomas utilizing JES classification, the criteria of which are based on the degree of irregularity in the microvascular morphology. Type A microvessels corresponded to noncancerous lesions and lack severe irregularity; type B, to cancerous lesions, and exhibit severe irregularity. Type B vessels were subclassified into B1, B2, and B3, diagnostic criteria for T1a-EP or T1a-LPM, T1a-MM or T1b-SM1, and T1b-SM2 tumors, respectively. We enrolled 211 patients with superficial esophageal squamous cell carcinoma. The overall accuracy of type B microvessels in estimating tumor invasion depth was 90.5 %. We propose that the newly developed JES magnifying endoscopic classification is useful in estimating the invasion depth of superficial esophageal squamous cell carcinoma.


Esophageal cancer; Invasion depth; Japan esophageal society classification; Magnifying endoscopy; Squamous cell carcinoma

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