Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2016; 22(41): 9196-9204
Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9196
Simplified criteria for diagnosing superficial esophageal squamous neoplasms using Narrow Band Imaging magnifying endoscopy
Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Masayuki Kato, Kazuki Sumiyama, Masato Matsushima, Shinichi Hirooka, Masahiro Ikegami, Hisao Tajiri
Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Masayuki Kato, Department of Endoscopy, The Jikei University Katsushika Medical Center, Toky 125-0062, Japan
Masato Matsushima, Division of Clinical Epidemiology, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Shinichi Hirooka, Masahiro Ikegami, Department of Pathology, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Hisao Tajiri, Department of Innovative Interventional Endoscopy Research, The Jikei University School of Medicine, Tokyo 105-8461, Japan
Author contributions: Dobashi A designed and performed the research and wrote the paper; Goda K designed and performed the research and wrote the paper; Yoshimura N, Sumiyama K, Hirooka S, Ikegami M, Tajiri H supervised the report; Kato M, Matsushima M designed the research and contributed to statistical analysis; Ohya TR was an English narrator and supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Jikei University School of Medicine
Informed consent statement: This study was carried out as a post-hoc analysis by using the data from our previous study of randomized controlled trial. All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We have no financial relationship to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kenichi Goda, MD, PhD, Associate Professor, Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan. kengoendoscopy@hotmail.co.jp
Telephone: +81-3-34331111-3181 Fax: +81-3-34594524
Received: June 21, 2016
Peer-review started: June 22, 2016
First decision: August 8, 2016
Revised: August 20, 2016
Accepted: September 14, 2016
Article in press: September 14, 2016
Published online: November 7, 2016
Processing time: 137 Days and 17.5 Hours
Abstract
AIM

To simplify the diagnostic criteria for superficial esophageal squamous cell carcinoma (SESCC) on Narrow Band Imaging combined with magnifying endoscopy (NBI-ME).

METHODS

This study was based on the post-hoc analysis of a randomized controlled trial. We performed NBI-ME for 147 patients with present or a history of squamous cell carcinoma in the head and neck, or esophagus between January 2009 and June 2011. Two expert endoscopists detected 89 lesions that were suspicious for SESCC lesions, which had been prospectively evaluated for the following 6 NBI-ME findings in real time: “intervascular background coloration”; “proliferation of intrapapillary capillary loops (IPCL)”; and “dilation”, “tortuosity”, “change in caliber”, and “various shapes (VS)” of IPCLs (i.e., Inoue’s tetrad criteria). The histologic examination of specimens was defined as the gold standard for diagnosis. A stepwise logistic regression analysis was used to identify candidates for the simplified criteria from among the 6 NBI-ME findings for diagnosing SESCCs. We evaluated diagnostic performance of the simplified criteria compared with that of Inoue’s criteria.

RESULTS

Fifty-four lesions (65%) were histologically diagnosed as SESCCs and the others as low-grade intraepithelial neoplasia or inflammation. In the univariate analysis, proliferation, tortuosity, change in caliber, and VS were significantly associated with SESCC (P < 0.01). The combination of VS and proliferation was statistically extracted from the 6 NBI-ME findings by using the stepwise logistic regression model. We defined the combination of VS and proliferation as simplified dyad criteria for SESCC. The areas under the curve of the simplified dyad criteria and Inoue’s tetrad criteria were 0.70 and 0.73, respectively. No significant difference was shown between them. The sensitivity, specificity, and accuracy of diagnosis for SESCC were 77.8%, 57.1%, 69.7% and 51.9%, 80.0%, 62.9% for the simplified dyad criteria and Inoue’s tetrad criteria, respectively.

CONCLUSION

The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBI-ME.

Keywords: Simplified criteria; Narrow Band Imaging; Magnifying endoscopy; Esophageal cancer; Squamous cell carcinoma; Endoscopic diagnosis; Classification; Superficial squamous cell carcinoma; Stepwise logistic regression analysis

Core tip: Narrow Band Imaging combined with magnifying endoscopy (NBI-ME) significantly improves the diagnostic accuracy for superficial esophageal squamous cell carcinoma (SESCC). However, currently used NBI-ME diagnostic criteria may confuse endoscopists and inhibit the widespread use of NBI-ME. The findings of this study suggest that simplified dyad criteria composed of the presence of “proliferation of intrapapillary capillary loops (IPCL)” and “various shapes (VS) of IPCLs” had comparable diagnostic performance to Inoue’s tetrad criteria, which are the most popular diagnostic criteria for SESCC. Proliferation and VS may serve as simplified NBI-ME criteria for diagnosing SESCC.