Clinical Significance of AVA in Diagnosing of Invasion Depth of Superficial Esophageal Cancer Dai Hirasawa 1 , Naotaka Fujita 1 , Yuki Maeda 1 , Tetsuya Ohira 1 , Yoshihiro Harada 1 , Yoshiki Koike 1 , Kenjiro Suzuki 1 , Taku Yamagata 1 , Megumi Tanaka 1 , Reina Yamada 1 , Yutaka Noda 1 1Department of Gastroenterology, Sendai City Medical Center, Sendai Open Hospital, Sendai, Japan Keyword: 日本食道学会分類 , 拡大内視鏡分類 , avascular area , 食道癌 , NBI pp.196-203
Published Date 2014/2/25
DOI https://doi.org/10.11477/mf.1403114073
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 The AVA(avascular area)is described in the JES(Japan Esophageal Society)classification published in 2011 as a supplementary item. AVA is defined as an enclosed type B vessel and an area with sparse vessels with the invasion depth differing according to the size. We conducted a study to verify the usefulness and necessity of the AVA. The AVA was confirmed in 97 of 126 foci(23.0%). The size of the AVA was small in 20 foci, middle in 5 foci, and large in 1 focus. The AVA tended to be more easily recognized when tumor size was larger and invasion depth was deeper. The tumor reached the epithelium or lamina propria mucosa(T1a-EP-LPM)in 95% of small AVAs and the muscularis mucosa and submucosa up to 0.2mm(T1a-MM-T1b-SM1)in 80% of the middle AVAs. The accuracy of the AVA invasion depth described in the JES classification is thus high at 92.3%. Most of the vessels at the AVA margin were type B2 and non-loop-shaped, suggesting T1a-MM-T1b-SM1, but small AVAs usually remained at T1a-EP-LPM. It is appropriate to diagnose the invasion depth as shallow if the AVA is small, even if it is type B2. Furthermore, AVA diagnosis may have great clinical significance from the perspective of diagnosing the invasion depth through the follow-up period.

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