Correlation between endoscopic macroscopic type and invasion depth for early esophagogastric junction adenocarcinomas

Although correlations between endoscopic macroscopic type and tumor depth have been reported for superficial esophageal squamous cell carcinoma and early gastric and early colorectal adenocarcinomas, there is no published study investigating the correlation between endoscopic macroscopic type and invasion depth for mucosal (M) and submucosal (SM) adenocarcinomas located at the esophagogastric junction (EGJ). We decided to analyze, therefore, the relationship between endoscopic macroscopic type and tumor depth for such cancers.

We retrospectively reviewed 73 early EGJ adenocarcinomas (M/SM = 33/40; differentiated/undifferentiated type = 70/3) in 73 consecutive patients treated endoscopically and/or surgically between January 2000 and December 2008. The mean age of the patients was 63.9 years (range 37-85 years) and the male/female ratio was 62:11. EGJ adenocarcinoma was defined as junctional carcinoma (type II) according to the Siewert classification.

We found polypoid type lesions (0-I) in 14 patients, non-polypoid type without mixed type (0-IIa, 0-IIb, or 0-IIc) in 39, and mixed type (0-IIa + IIc or 0-IIc + IIa) in 20 patients. Non-polypoid type without mixed type (31%; 12/39) lesions had a significantly lower risk for SM invasion compared to polypoid type (79%; 11/14; p < 0.01) and mixed type (85%; 17/20; p < 0.01) lesions. In polypoid type lesions, the risk of SM invasion was significantly lower for the pedunculated subtype (0-Ip) than for the sessile subtype (0-Is) lesions (0%; 0/2 vs. 92%; 11/12; p < 0.05). M lesions (mean size 14.5 ± 7.5 mm) were significantly smaller than SM lesions (24.5 ± 7.7 mm; p < 0.01).

Determination of endoscopic macroscopic type may be useful in accurately diagnosing early EGJ adenocarcinoma invasion depth.