Diagnosis of invasion depth for esophagogastric junction adenocarcinoma: Focusing on histological-type diagnosis using magnifying endoscopy with narrow-band imaging

Background: The histological-type and tumor depth of intramucosal (M) and submucosal invasive (SM) cancers, e.g., esophageal squamous cell carcinoma and colorectal adenocarcinoma, are reported to be correlated. However, it is unclear whether they are correlated or not in esophagogastric junction adenocarcinoma (EGJA). This study evaluated the relationship between clinicopathological findings, including the endoscopic estimation of histological-type, and invasion depth of EGJA.
Methods: We retrospectively reviewed 116 early EGJAs (M/SM=89/27) in 114 patients treated endoscopically and/or surgically between October 2005 and July 2019.
EGJA was defined according to Nishi’s classification. The endoscopic estimation of histological-type was performed using magnifying endoscopy with narrow-band imaging (ME-NBI). In endoscopic estimation, wavy microvessels or corkscrew patterns were considered to be indicative of an undifferentiated component (UD-component).
Results: In multivariate analysis, a UD-component on ME-NBI was the only significant predictive factor for SM invasion (OR: 5.0, 95% CI: 1.3–19.6; P=0.022). A quite high concordance (94.8%) was obtained between endoscopic estimation and histological diagnosis, and 66.7% of lesions with a UD-component on ME-NBI had SM invasion.
Conclusions: Lesions with a UD-component on ME-NBI are likely to be SM invasive. An accurate preoperative estimation of histological-type is important for determining the appropriate treatment.