Table 1.
Category | Diagnosis |
Group 1 | Negative for neoplasia |
Group 2 | Indefinite for neoplasia |
Group 3 | Mucosal low grade neoplasia |
Low grade adenoma | |
Low grade dysplasia | |
Group 4 | Mucosal high grade neoplasia |
Subgroup 4.1 | High grade adenoma/dysplasia |
Subgroup 4.2 | Non-invasive carcinoma (carcinoma in situ) |
Subgroup 4.3 | Suspicious for invasive carcinoma |
Subgroup 4.4 | Intramucosal carcinoma |
Group 5 | Submucosal invasion by carcinoma |
The Endocytoscopic Atypia (ECA) Classification[10] for superficial esophageal squamous cell lesions is as follow: ECA 1: Large, cytoplasm-rich cells with a rhomboid shape are found in a regular arrangement. Small nuclei are located at their center. This appearance corresponds to healthy squamous epithelium in the esophagus; ECA 2: The cell margin often becomes round. Different-sized small nuclei are observed. The image often shows inflammatory or reactive changes; ECA 3: The cell becomes smaller in size but the nuclei are still compact. This appearance is often observed in borderline lesions; ECA 4: The number of cells increases with an increased nucleus-cytoplasm ratio. This appearance strongly suggests a malignant lesion; ECA 5: Cells of various sizes are arranged irregularly with a high nucleus-cytoplasm ratio. This appearance is recognized endoscopically as a definitely malignant lesion. All images were categorized according to size and uniformity of nuclei, number of cells and regularity of cellular arrangement. Higher ECA category is associated with stronger atypia. ECA 1 to ECA 3 corresponds to Vienna categories 1 to 3; ECA 4 to ECA 5 corresponds to Vienna categories 4 to 5. The data was quoted from the references of 13, 14.