I Ilse N Beaufort, N Nicolaas A P Zuithoff, L Lodewijk A A Brosens, K Kazuhiro Furukawa, O Osamu Goto, A Arjun D Koch, M Maartje van de Meeberg, W Wouter B Nagengast, R Roos E Pouw, K Kuna Rueb, C Caroline Saleh, E Erik J Schoon, S Stefan Seewald, S Shunsuke Yamamoto, M Marnix Jansen, B Bas L A M Weusten
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We aimed to assess its diagnostic reproducibility and accuracy in Western ESCN patients.</p><p><strong>Methods: </strong>Intrapapillary capillary loops on endoscopic images of Western ESCN lesions (n = 113) collected between 2010 and 2022 were assessed by nine endoscopists, including three Japanese expert endoscopists, three Western expert endoscopists, and three residents-in-training, and graded according to the JES microvessel classification where microvessel type A corresponds with normality or low-grade intraepithelial neoplasia, and microvessel types B1, B2, and B3 correspond with high-grade intraepithelial neoplasia or invasion into the lamina propria, muscularis mucosae or superficial submucosa, and deep submucosa, respectively. Outcomes included overall accuracy in predicting ESCN invasion depth and interobserver agreement.</p><p><strong>Results: </strong>Good interobserver agreement was observed among expert endoscopists (Krippendorf's alpha 0.64, 95% CI 0.57-0.70), while agreement was moderate among residents-in-training (Krippendorf's alpha 0.58, 95% CI 0.52-0.72). Overall accuracy of the JES microvessel classification was 53% (95% CI 42-63), 52% (95% CI 41-62), and 44% (95% CI 34-55) for Japanese endoscopists, Western endoscopists, and residents-in-training, respectively. Sensitivity and specificity for vessel type A, B1, B2, and B3 across assessors were 0%-50% and 89%-100%, 55%-64% and 66%-77%, 42%-71% and 60%-76%, and 10%-24% and 92%-97%, respectively. 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引用次数: 0
摘要
背景：日本食管学会提出了JES微血管分类法，以毛细血管内环评估为基础，评估早期食管鳞状细胞瘤（ESCN）是否符合内镜下切除的条件。我们的目的是评估其在西方ESCN患者中的诊断重现性和准确性：方法：2010 年至 2022 年期间收集的西方 ESCN 病变（n = 113）内窥镜图像上的毛细血管内环路由九位内窥镜医师进行评估，其中包括三位日本内窥镜专家、三位西方内窥镜专家和三位实习住院医师、微血管类型A对应正常或低级别上皮内瘤变，微血管类型B1、B2和B3分别对应高级别上皮内瘤变或侵入固有层、粘膜肌层或粘膜浅层和粘膜深层。结果包括预测 ESCN 侵袭深度的总体准确性和观察者间的一致性：结果：在内镜专家中观察到了良好的观察者间一致性（Krippendorf's alpha 0.64，95% CI 0.57-0.70），而在培训住院医师中观察到了中等程度的一致性（Krippendorf's alpha 0.58，95% CI 0.52-0.72）。日本内镜医师、西方内镜医师和培训住院医师的JES微血管分类总体准确率分别为53%（95% CI 42-63）、52%（95% CI 41-62）和44%（95% CI 34-55）。不同评估者对血管类型 A、B1、B2 和 B3 的敏感性和特异性分别为 0%-50% 和 89%-100%、55%-64% 和 66%-77%、42%-71% 和 60%-76% 以及 10%-24% 和 92%-97%。B3血管的阴性预测值介于80%和85%之间：西方ESCN患者JES微血管分类的总体准确率较低，但经验丰富的内镜医师评估的B3血管缺失可能预示浅表ESCN适合内镜切除。试验登记：www.trialregister.nl; NL8897 (6-9-2020)。
The Japanese Esophageal Society classification for prediction of superficial esophageal squamous cell neoplasia invasion depth: Validation in a Western population.
Background: The Japan Esophageal Society proposed the JES microvessel classification to assess eligibility of early esophageal squamous cell neoplasia (ESCN) for endoscopic resection based on intrapapillary capillary loop assessment. We aimed to assess its diagnostic reproducibility and accuracy in Western ESCN patients.
Methods: Intrapapillary capillary loops on endoscopic images of Western ESCN lesions (n = 113) collected between 2010 and 2022 were assessed by nine endoscopists, including three Japanese expert endoscopists, three Western expert endoscopists, and three residents-in-training, and graded according to the JES microvessel classification where microvessel type A corresponds with normality or low-grade intraepithelial neoplasia, and microvessel types B1, B2, and B3 correspond with high-grade intraepithelial neoplasia or invasion into the lamina propria, muscularis mucosae or superficial submucosa, and deep submucosa, respectively. Outcomes included overall accuracy in predicting ESCN invasion depth and interobserver agreement.
Results: Good interobserver agreement was observed among expert endoscopists (Krippendorf's alpha 0.64, 95% CI 0.57-0.70), while agreement was moderate among residents-in-training (Krippendorf's alpha 0.58, 95% CI 0.52-0.72). Overall accuracy of the JES microvessel classification was 53% (95% CI 42-63), 52% (95% CI 41-62), and 44% (95% CI 34-55) for Japanese endoscopists, Western endoscopists, and residents-in-training, respectively. Sensitivity and specificity for vessel type A, B1, B2, and B3 across assessors were 0%-50% and 89%-100%, 55%-64% and 66%-77%, 42%-71% and 60%-76%, and 10%-24% and 92%-97%, respectively. Negative predictive value ranged between 80% and 85% for B3 vessels.
Conclusion: Overall accuracy of the JES microvessel classification in Western ESCN patients is low, though absence of B3 vessels as assessed by experienced endoscopists may predict superficial ESCN amenable to endoscopic resection.
期刊介绍：
United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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