Accuracy of clinical diagnosis for T1a-EP/LPM esophageal cancer depends on the size of lesions

Background: Accuracy of endoscopic diagnosis for EP/LPM esophageal squamous cell carcinoma (ESCC) in relation to lesions’ size is not clarified yet.
Methods: We retrospectively investigated pathological diagnoses of clinically diagnosed (c)EP/LPM ESCC using endoscopically resected specimens between January 2015 and December 2019.
Results: Of 1271 cEP/LPM cancers, 1195 (94.0%) were correctly diagnosed as pEP/LPM cancers. Subgroup analyses of lesions classified by lesions’ size and circumferential spread are shown in the Table. Diagnostic accuracy of cEP/LPM was associated with lesions’ size (P<0.001) and circumferential spread (P<0.001). In addition, the proportion of high-risk cancers, defined by submucosal invasion or lymphovascular involvement, was significantly higher in lesions ≥ 50mm (20.6%) and ≥ 3/4 (12.2%).
Conclusion: Treatment should be determined considering the higher risk of cancer invasion into the muscularis mucosa or deeper in cEP/LPM cancers ≥ 50mm or ≥ 3/4 circumferential extent.