The macroscopic appearance of early gastric cancers, classified according to the Japanese criteria, has been shown to be an important prognostic factor for local endoscopic therapy.
There is no prospective data about the distribution of macroscopic types, however, their location in early Barrett's neoplasia are available.
The present study was conducted to evaluate the clinical applicability of this macroscopic classification.
|The mean kappa value for the interobserver agreement was 0.86|
Dr Pech and colleagues from Germany analyzed the relative proportions of the different gross types in early Barrett's neoplasms.
The research team assessed the correlation between the macroscopic classification, and the stage or grade of differentiation.
The team investigated a total of 344 patients with 380 Barrett's neoplastic lesions between 1996 and 2005.
For endoscopic therapy of early Barrett's high-grade intraepithelial neoplasia and carcinoma were prospectively included in the study.
Routine endoscopy prior to endoscopic resection in the team's center included assessment of the macroscopic type, and documentation of the radial location of the neoplastic lesions.
The researchers recorded images, which were later assessed by 6 independent reviewers.
Intra- and interobserver agreement for the assessment of the macroscopic type were calculated using kappa statistics.
The distribution of the lesions by gross type included 49 patients as type I, 139 as type IIa, 106 as type IIb, 17 as type IIc, 62 as type IIa + c, and 7 as type III.
The team noted that type IIb lesions seem to be the most favorable type with regard to differentiation and T category.
The mean kappa value for the interobserver agreement was 0.86, and the mean kappa value for the intraobserver agreement was 0.89.
The research team observed that most lesions were found at the 12 o'clock and 3 o'clock positions.
Dr Pech's team concluded, "Assessment of the macroscopic type may provide important information about the possibility of endoscopic treatment."
"The harder-to-detect flat lesions are by far the most frequent macroscopic type of neoplastic lesion in Barrett's esophagus."