Tajiri A, Ishihara R, Sakurai H, et al. - In this attempt to clarify the link between pathological invasion depth and lesion size or circumference in clinical (c) epithelial/lamina propria (EP/LPM) esophageal cancers, findings showed that positive predictive value (PPV) of cEP/LPM esophageal squamous cell carcinoma (ESCC) was associated with lesion size.

• Of 1,271 cancer patients with cEP/LPM ESCC, 1,195 (94.0%) were correctly diagnosed with pathological T1a-epithelial/lamina propria (pEP/LPM) cancer.

• PPV divided based on lesion sizes of ≤25 mm, 26–49 mm, and ≥50 mm was 95.8% (981/1024 lesions), 89.7% (191/213 lesions), and 67.6% (23/34 lesions), respectively.

• PPV based on circumferential extent of <3/4, ≥3/4 and <1, and whole was reported to be 94.6% (1164/1230 lesions), 75.0% (24/32 lesions), and 77.8% (7/9 lesions), respectively.

• Multivariate analysis demonstrated that PPV of cEP/LPM ESCC was significantly related to lesion size and male gender.

• Treatment should be decided considering the high risk of cancer invasion into the muscularis mucosa or deeper in cEP/LPM cancers with a lesion size of ≥50 mm.