title: Simplified criteria for diagnosing superficial esophageal squamous neoplasms using Narrow Band Imaging magnifying endoscopy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  The combination of proliferation and VS may serve as simplified criteria for the diagnosis of SESCC using NBI-ME.
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Dobashi
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Goda
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Yoshimura
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Tomohiko R
authors.initials: TR
authors.lastname: Ohya
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kato
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Matsushima
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Hirooka
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ikegami
authors.affiliation: Akira Dobashi, Kenichi Goda, Noboru Yoshimura, Tomohiko R Ohya, Kazuki Sumiyama, Department of Endoscopy, The Jikei University School of Medicine, Tokyo 105-8461, Japan.
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D049109:Cell Proliferation; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062048:Narrow Band Imaging; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D012372:ROC Curve; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Classification; Endoscopic diagnosis; Esophageal cancer; Magnifying endoscopy; Narrow Band Imaging; Simplified criteria; Squamous cell carcinoma; Stepwise logistic regression analysis; Superficial squamous cell carcinoma