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Investigators evaluated endoscopic predictors of submucosal invasive cancer (SMIC) in patients referred for endoscopic mucosal resection. Such predictors might help identify lesions that might better be sent to surgery or for endoscopic submucosal dissection versus endoscopic mucosal resection.
They studied 2277 lesions (mean size, 36.9 mm). The main predictors that were considered overt evidence of cancer at endoscopic inspection were Kudo V pit pattern (odds ratio, 12.1) and a depressed Paris IIc component. The Kudo V pit pattern was 40.4% sensitive and had a 56.6% positive predictive value for SMIC; the depressed component was 21.1% sensitive with a 29.3% positive predictive value. Therefore, many cancers were not discovered until after r…