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A New Scoring System to Distinguish Deep Invasive Submucosal (T1) and Muscularis Propria (T2) Colorectal Cancer during Colonoscopy: A Development and Global Multicenter External Validation Study (e-T2 Score).

Y. Koyama,M. Yamada,M. Makiguchi,M. Sekiguchi,H. Takamaru,T. Sakamoto,S. Kono,M. Fukuzawa,Shih Yea Sylvia Wu,Arjun Sugumaran,T. Kawai,T. Matsuda,T. Itoi,Yutaka Saito

Published 2022 in Gastrointestinal Endoscopy

ABSTRACT

BACKGROUND AND AIMS Diagnostics to differentiate deep submucosal invasive (T1b) colorectal cancer (CRC) from muscularis propria invasive (T2) CRC are limited. We aimed to establish and validate a scoring system that differentiates T1b from T2. METHODS A multicenter retrospective cross-validation study was performed. Consecutive pathologically confirmed 461 T1b or T2 CRCs were divided into the development (T1b: 222; T2: 189), and internal validation cohorts (T1b: 31; T2: 19). Following 8 potential endoscopic findings were evaluated using the development cohort: loss of lobulation, deep depression, demarcated depressed area, protuberance within the depression, expanding appearance, fold convergency, erosion or white plaque, and Borrmann type 2 or 3 tumor. A scoring system that differentiates T1b from T2 was developed, and diagnostic performance was tested using the internal validation cohort by 8 endoscopists. External validation was conducted using 50 CRC images by 4 endoscopists from other institutions, including outside of Japan. RESULTS Multivariate analysis identified the following 5 independent predictive endoscopic findings of T2 CRC: deep depression (OR: 2.08, 95% CI: 1.07-4.04), demarcated depressed area (4.40, 1.39-13.9), 4-fold convergency or more (3.41, 1.90-6.11), erosion or white plaque (8.28, 2.77-24.7), and Borrmann type 2 or 3 tumor (8.76, 3.58-21.5). The area under the curve in the receiver-operating characteristics were 0.90 (95%CI: 0.87-0.93) in development cohort, 0.80 (0.76-0.85) in internal validation, and 0.76 (0.69-0.83) in external validation, respectively. CONCLUSIONS We established and validated a new scoring system to differentiate T1b and T2 CRC using 5 simple endoscopic findings.

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