Tajiri A, Ishihara R, Sakurai H, et al. - Positive predictive value (PPV) of clinical (c) EP/LPM (epithelial/lamina propria) esophageal squamous cell carcinoma (ESCC) was found to be associated with lesion size.

• In ESCC, it is justified to perform endoscopic resection (ER) in cases with pathological T1a-epithelial/lamina propria (pEP/LPM) cancers that can be cured by ER.

• Using a database, the link between pathological invasion depth and lesion size or circumference in cEP/LPM cancers was investigated in this study.

• Diagnosis of cEP/LPM ESCC was made in 1,271 cancer patients between January 2015 and December 2019, of which 1,195 (94.0%) were accurately diagnosed with pEP/LPM cancer.

• For lesion sizes of ≤25, 26–49, and ≥50 mm, PPV was 95.8%, 89.7%, and 67.6%, respectively.

• PPV based on the circumferential extent of <3/4, ≥3/4, and <1, and whole was 94.6%, 75.0%, and 77.8%, respectively.

• Therapeutic strategy should be determined considering the high risk of cancer invasion into the muscularis mucosa or deeper in cEP/LPM malignancies with a lesion size of ≥50 mm.