Irregularly branched microvessels as visualized by magnifying endoscopy: a reliable marker for predicting deep submucosal invasion of superficial esophageal squamous cell carcinoma

Abstract

Background and study aims Magnifying endoscopy with narrow-band imaging (M-NBI) is reported to be useful in diagnosing invasion depth of superficial esophageal squamous cell carcinoma (SCC), but accurate diagnosis of deep submucosal invasion (SM2) has remained difficult. However, we discovered that irregularly branched microvessels observed with M-NBI are detected in SM2 cancers with high prevalence. Thus, this retrospective study aimed to investigate the diagnostic performance of irregularly branched microvessels as visualized by M-NBI for predicting SM2 cancers.

Patients and methods Patients with superficial esophageal SCC lesions that were endoscopically or surgically resected at our hospital between September 2005 and December 2014 were included. Endoscopic findings by M-NBI of these lesions were presented to an experienced endoscopist who was unaware of the histopathological diagnosis and who then judged whether irregularly branched microvessels were present. Using the invasion depth according to postoperative histopathological diagnosis as the gold standard, we determined the diagnostic performance of the presence of irregularly branched microvessels as an indicator for SM2 cancers.

Results A total of 302 superficial esophageal SCC lesions (228 patients) were included in the analysis. When irregularly branched microvessels were used as an indicator of SM2 cancers, the diagnostic accuracy was 94.0 % (95 % confidence interval [CI]: 91.1–96.1 %), sensitivity was 79.4 % (95 % CI: 66.6–88.4 %), specificity was 95.9 % (95 % CI: 94.3–97.0 %), positive predictive value was 71.1 % (95 % CI: 59.6–79.1 %), and negative predictive value was 97.3 % (95% CI: 95.7–98.5 %).

Conclusions Irregularly branched microvessels may be a reliable M-NBI indicator for the diagnosis of cancers with deep submucosal invasion.

• References

• 1 Oyama T, Miyata Y, Shimatani S. et al. Lymph nodal metastasis of m3, sm1 esophageal cancer (in Japanese with English abstract). Stomach and Intest 2002; 37: 71-74
• 2 Tachibana M, Yoshimura H, Kinugasa S. et al. Clinicopathological features of superficial squamous cell carcinoma of the esophagus. Am J Surg 1997; 174: 49-53
• 3 Endo M, Yoshino K, Takeshita K. et al. Analysis of 1125 cases of early esophageal carcinoma in Japan. Dis Esophagus 1991; 4: 125-129
• 4 Kodama M, Kakegawa T. Treatment of superficial cancer of the esophagus: a summary of responses to a questionnaire on superficial cancer of the esophagus in Japan. Surgery 1998; 123: 432-439
• 5 Araki K, Ohno S, Egashira A. et al. Pathologic features of superficial esophageal squamous cell carcinoma with lymph node and distal metastasis. Cancer 2002; 94: 570-575
• 6 Eguchi T, Nakanishi Y, Shimoda T. et al. Histopathological criteria for additional treatment after endoscopic mucosal resection for esophageal cancer: analysis of 464 surgically resected cases. Mod Pathol 2006; 19: 475-480
• 7 Yamashina T, Ishihara R, Nagai K. et al. Long-term outcome and metastatic risk after endoscopic resection of superficial esophageal squamous cell carcinoma. Am J Gastroenterol 2013; 108: 544-551
• 8 The Japan Esophageal Society . Guidelines for diagnosis and treatment of carcinoma of the esophagus 2017. Tokyo: Kanehara & Co Ltd; 2017
• 9 Takeuchi H, Miyata H, Gotoh M. et al. A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg 2014; 260: 259-266
• 10 Inoue H. Magnification endoscopy in the esophagus and stomach. Dig Endosc 2001; 13: S40-S41
• 11 Arima M, Tada M, Arima H. Evaluation of microvascular patterns of superficial esophageal cancers by magnifying endoscopy. Esophagus 2005; 2: 191-197
• 12 Oyama T, Monma K. A new classification of magnified endoscopy for superficial esophageal squamous cell carcinoma. Esophagus 2011; 8: 247-251
• 13 Takeuchi M, Hashimoto S, Kobayashi M. et al. Prospective study of the usefulness of type B2 vessel determined by the Japan Esophageal Society classification of magnified endoscopy for the diagnosis of superficial esophageal squamous cell carcinoma. Stomach Intest 2014; 49: 164-172 (in Japanese with English abstract)
• 14 Fujiwara J, Monma K, Tateishi Y. et al. Endoscopic and pathological studies on type B2 blood vessels in estimation of invasion depth of superficial esophageal cancer. Stomach Intest 2014; 49: 174-185 (in Japanese with English abstract)
• 15 Ikeda H, Inoue H, Sato H. et al. Usefulness of a new classification by the Japan Esophageal Society to predict the depth of invasion of esophageal cancer – type B3 vessels. Stomach Intest 2014; 49: 186-195 (in Japanese with English abstract)
• 16 Japan Esophageal Society. Japanese classification of esophageal cancer. 11^th English edition Tokyo: Kanehara & Co Ltd; 2015
• 17 Landis JR, Koch GG. An application of hierarchical kappa-type statistics in the assessment of majority agreement among multiple observers. Biometrics 1977; 33: 362-374
• 18 Chino O, Makuuchi H, Shimada H. et al. Diagnosis of the invasion depth of superficial esophageal carcinoma. Gastroenterol Endosc 2015; 57: 1243-1253 (in Japanese with English abstract)
• 19 Murata Y, Napoleon B, Odegaard S. High-frequency endoscopic ultrasonography in the evaluation of superficial esophageal cancer. Endoscopy 2003; 35: 429-436
• 20 Oyama T, Inoue H, Arima M. et al. Prediction of the invasion depth of superficial squamous cell carcinoma based on microvessel morphology: magnifying endoscopic classification of the Japan Esophageal Society. Esophagus 2016; 13: 138-145
• 21 Kumagai Y, Toi M, Kawada K. et al. Angiogenesis in superficial esophageal squamous cell carcinoma: magnifying endoscopic observation and molecular analysis. Dig Endosc 2010; 22: 259-267