# Unified Magnifying Endoscopic Classification (UMEC) of Gastrointestinal Lesions: A North American Validation Study

## TL;DR

This study validates a new endoscopic classification system for diagnosing gastrointestinal cancers in North America.

## Contribution

The study introduces and validates the Unified Magnifying Endoscopic Classification (UMEC) for gastrointestinal lesions in a North American context.

## Key findings

- UMEC showed high accuracy for diagnosing gastric adenocarcinoma with sensitivity ranging up to 100%.
- Diagnostic accuracy for colorectal adenocarcinoma ranged from 86.8% to 90.7% using UMEC.
- Endoscopists achieved good to excellent reliability in using UMEC for lesion classification.

## Abstract

Magnifying endoscopy enables the diagnosis of advanced neoplasia throughout the gastrointestinal tract. The unified magnifying endoscopic classification (UMEC) framework unifies optical diagnosis criteria in the esophagus, stomach, and colon, dividing lesions into three categories: non-neoplastic, intramucosal neoplasia, and deep submucosal invasive cancer. This study aims to ascertain the performance of North American endoscopists when using the UMEC.

In this retrospective cohort study, five North American endoscopists without prior training in magnifying endoscopy independently diagnosed images of gastrointestinal tract lesions using UMEC. All endoscopists were blinded to endoscopic findings and histopathological diagnosis. Using histopathology as the gold standard, the endoscopists’ diagnostic performances using UMEC were evaluated.

A total of 299 lesions (77 esophagus, 92 stomach, and 130 colon) were assessed. For esophageal squamous cell carcinoma, the sensitivity, specificity, and accuracy ranged from 65.2% (95%CI: 50.9–77.9) to 87.0% (95%CI: 75.3–94.6), 77.4% (95%CI: 60.9–89.6) to 96.8% (95%CI: 86.8–99.8), and 75.3% to 87.0%, respectively. For gastric adenocarcinoma, the sensitivity, specificity, and accuracy ranged from 94.9% (95%CI: 85.0–99.1) to 100%, 52.9% (95%CI: 39.4–66.2) to 92.2% (95%CI: 82.7–97.5), and 73.3% to 93.3%. For colorectal adenocarcinoma, the sensitivity, specificity, and accuracy ranged from 76.2% (95%CI: 62.0–87.3) to 83.3% (95%CI: 70.3–92.5), 89.7% (95%CI: 82.1–94.9) to 97.7% (95%CI: 93.1–99.6), and 86.8% to 90.7%. Intraclass correlation coefficients indicated good to excellent reliability.

UMEC is a simple classification that may be used to introduce endoscopists to magnifying narrow-band imaging and optical diagnosis, yielding satisfactory diagnostic accuracy.