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Diagnostic yield of conventional endoscopy with endoscopic ultrasonography for submucosal invasion of superficial esophageal squamous cell carcinoma: a post hoc analysis of multicenter prospective confirmatory study (JCOG0508)

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Abstract

Background

Endoscopic ultrasonography (EUS) is reportedly the reliable modality to predict the depth of esophageal squamous cell carcinoma (ESCC), however, most previous studies are retrospective or single-centered. We aimed to evaluate the diagnostic ability of conventional endoscopy and EUS using the data from a multicenter prospective study of endoscopic resection (ER) followed by chemoradiotherapy for cSM1-2N0M0 ESCC (JCOG0508).

Methods

All lesions were evaluated as cSM cancer with both conventional endoscopy and EUS before enrollment and judged as cSM1 or cSM2 in real time. We compared the clinical and pathological diagnoses for tumor depth and assessed the positive predictive value (PPV) for pSM (pSM/cSM) as the primary endpoint. We also investigated the clinical factors affecting the pathological depth of SM.

Results

175 lesions were examined, and clinical diagnosis was SM1 in 114 and SM2 in 61 lesions. The pathological diagnoses of the epithelium, lamina propria mucosa, muscularis mucosae, SM1, and SM2 were 3, 31, 55, 17, and 69. The PPV for pSM was 49.1% (86/175) in all lesions, 34.2% (39/114) in cSM1 lesions, and 77.0% (47/61) in cSM2 lesions. Multivariable analysis demonstrated that cSM2 (vs. cSM1, OR 6.79) was an independent clinical factor associated with pSM.

Conclusions

While the accurate depth diagnosis in cSM ESCC was difficult to make, the clinical diagnosis of SM2 with both conventional endoscopy and EUS was significantly associated with pSM. Furthermore, diagnostic ER could be recommended to confirm the pathological diagnosis especially in cSM1 lesions with both conventional endoscopy and EUS.

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Acknowledgements

We express our sincere thanks to all participating patients and their families. We thank the members of the JCOG Data Center/Operations Office for their support.

Funding

This study was supported in part by the National Cancer Center Research and Development Funds (23-A-16, 23-A-19, 26-A-4, 29-A-3, 2020-J-3), the Health and Labour Sciences Research Grant for Clinical Cancer Research (17-12, 20-015), the Grant-in-Aid for Scientific Research (17S-3, 17S-5, 20S-3, 20S-6) from the Ministry of Health, Labour and Welfare of Japan.

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Authors and Affiliations

  1. Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Tomohiro Kadota & Tomonori Yano

  2. Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan

    Tomohiro Kadota, Masashi Wakabayashi, Hiroshi Katayama & Haruhiko Fukuda

  3. Clinical Trial Promotion Department, Chiba Cancer Center, Chiba, Japan

    Keiko Minashi

  4. Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan

    Yasumasa Ezoe & Manabu Muto

  5. Department of Gastroenterology, Cancer Institute Ariake Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Tomohiro Tsuchida

  6. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

    Hiroyuki Ono & Kohei Takizawa

  7. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

    Toshiro Iizuka

  8. Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan

    Noriko Matsuura

  9. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Ichiro Oda

Authors
  1. Tomohiro Kadota
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  2. Keiko Minashi
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  3. Masashi Wakabayashi
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  4. Tomonori Yano
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  5. Yasumasa Ezoe
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  6. Tomohiro Tsuchida
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  7. Hiroyuki Ono
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  8. Toshiro Iizuka
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  11. Kohei Takizawa
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  14. Manabu Muto
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Contributions

TK, KM, TY, KT, HK, and MM designed the research; MW analyzed the data; TK wrote the manuscript; KM, MW, TY, YE, TT, HO, TI, NM, IO, KT, HK, HF, and MM reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Tomohiro Kadota.

Ethics declarations

Ethical Statement

This post hoc analysis was used collected data of JCOG0508 that complied with the Declaration of Helsinki requirements, which was approved by the institutional review boards of all participating institutions. The informed consent about the secondary use of the data was obtained from the enrolled patients at the registration to JCOG0508.

Conflict of interest

All authors declare no conflict of interest related to this article.

Participating institutions

Japan Clinical Oncology Group (JCOG) Gastrointestinal Endoscopy Study Group. Ibaraki Prefectural Central Hospital, Tochigi Cancer Center, National Cancer Center Hospital East, National Cancer Center Hospital, Chiba Cancer Center, Cancer Institute Hospital, Tokyo Metropolitan Komagome Hospital, Showa University, Toranomon Hospital, Kanagawa Cancer Center, Kitasato University Hospital, Yokohama City University Medical Center, Ishikawa Prefectural Central Hospital, Saku Central Hospital Advanced Care Center, Shizuoka Cancer Center, Aichi Cancer Center Hospital, Kyoto University, Osaka International Cancer Institute, Osaka City General Hospital, Osaka Medical Collage, Kobe University, Hyogo Cancer Center, Shikoku Cancer Center.

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10388_2021_815_MOESM1_ESM.tiff

ESM 1. A representative case. a) Reddish depression with surrounding slightly elevation was noted by conventional endoscopy (TIFF 785 KB)

b) The lesion was recognized as a brownish area by narrow band imaging (NBI) (TIFF 1286 KB)

c) The depression area of the lesion was negative to iodine staining (TIFF 423 KB)

10388_2021_815_MOESM4_ESM.tiff

d) Endoscopic ultrasonography showed a hypoechoic lesion in the layer 4/9, and layer 5/9 to be free of tumor invasions. The depth of tumor invasion was diagnosed as cT1b-SM1 (TIFF 910 KB)

e) The fixed specimen. The lesion is mapped by red and yellow lines (TIFF 1890 KB)

f) Histopathological image of the lesion revealed pT1b-SM2 (TIFF 406 KB)

10388_2021_815_MOESM7_ESM.tiff

ESM 2. A representative case. a) Reddish uneven depression with noticeable thickness was noted by conventional endoscopy (TIFF 559 KB)

b) The depression area of the lesion was negative to iodine staining (TIFF 464 KB)

10388_2021_815_MOESM9_ESM.tiff

c) Endoscopic ultrasonography showed a hypoechoic lesion spread in the layer 5/9. The depth of tumor invasion was diagnosed as cT1b-SM2 (TIFF 1165 KB)

d) The fixed specimen. The lesion is mapped by red lines (TIFF 2008 KB)

e) Histopathological image of the lesion revealed pT1a-MM (TIFF 1110 KB)

10388_2021_815_MOESM12_ESM.tiff

ESM 3. A representative case. a) Reddish depression with uneven surface was noted by conventional endoscopy (TIFF 1211 KB)

b) The depression area of the lesion was negative to iodine staining (TIFF 445 KB)

10388_2021_815_MOESM14_ESM.tiff

c) Endoscopic ultrasonography showed a hypoechoic lesion spread in the layer 5/9. The depth of tumor invasion was diagnosed as cT1b-SM2 (TIFF 1227 KB)

d) The fixed specimen. The lesion is mapped by red and light blue lines (TIFF 859 KB)

e) Histopathological image of the lesion revealed pT1b-SM2 (TIFF 1058 KB)

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Kadota, T., Minashi, K., Wakabayashi, M. et al. Diagnostic yield of conventional endoscopy with endoscopic ultrasonography for submucosal invasion of superficial esophageal squamous cell carcinoma: a post hoc analysis of multicenter prospective confirmatory study (JCOG0508). Esophagus 18, 604–611 (2021). https://doi.org/10.1007/s10388-021-00815-3

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  • DOI: https://doi.org/10.1007/s10388-021-00815-3

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