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CLASSIFICATION
Classification
JES classification (esophageal squamous, magnifying)
Magnifying endoscopic classification of esophageal squamous epithelium (Type A / B1 / B2 / B3).
Classification overview
Type A · Without severe irregularity
Type B1 · Loop-like formation
Type B2 · Non-loop, elongated
Type B3 · Highly dilated vessels
AVA · Avascular area
Type A
Without severe irregularity
Definition
Normal IPCL, or abnormal microvessels without severe irregularity
Invasion
No invasion
Histology
Normal epithelium, inflammation, and LGIN
Type B1
Loop-like formation
Definition
Type B vessels with a loop-like formation
Invasion
T1a-EP or T1a-LPM
Histology
HGIN and invasive SCC
Note
The B1 vessels normally appear as dot-like microvessels. The caliber of B1 vessels is around 20 μm.
Type B2
Non-loop, elongated
Definition
Type B vessels without a loop-like formation that have a stretched and markedly elongated transformation
Invasion
T1a-MM or T1b-SM1
Note
The B2 vessels often show a multilayered arrangement or an irregularly branched/running pattern.
Note: Esophageal SM1 is ≤200 μm.
Type B3
Highly dilated vessels
Definition
Highly dilated abnormal vessels whose caliber appears to be more than three times that of the usual B2 vessels
Invasion
T1b-SM2 or deeper
Note
The B3 vessels often appear green in color. The caliber of B3 vessels is often larger than 60 μm.
AVA
Avascular area
Definition
A low or no vascularity area surrounded by all subtypes of type B microvessels, including B1. The stretched irregular vessels themselves are not included in AVA.
AVA-small
Smaller than 0.5 mm in diameter
AVA-middle
0.5 mm or between 0.5 and 3 mm
AVA-large
3 mm or larger
B1
Any types of AVA (small, middle, and large) surrounded by B1 vessels are suggestive of T1a-EP or T1a-LPM SCC.
B2 / B3
AVA-middle surrounded by B2 or B3 vessels is suggestive of T1a-MM or T1b-SM1. AVA-large surrounded by B2 or B3 vessels is suggestive of T1b-SM2 invasive SCC.