Post written by Shinji Tanaka, MD, PhD, from Endoscopy and Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Japan.

By JNET classification using magnifying observation, it will be possible to characterize the lesions of NICE Type 2 more in detail. NICE Type 2 includes various lesion such as dysplasia, superficial submucosal carcinoma, and deep submucosal carcinoma. It has been required to distinguish between dysplasia and submucosal carcinoma.

NICE Type 1 is an indicator for hyperplasia/SSP, and Type 3 is an indicator for deep submucosal carcinoma. JNET classification Type 2A and 2B are nearly equal to the subclassification of NICE Type 2. As a result, JNET classification Type 1 stands for hyperplastic polyp (HP) and sessile serrated polyp (SSP). Type 2A stands for low-grade dysplasia (LGD), such as tubular adenoma/tubulovillous adenoma. Type 2B stands for high-grade dysplasia (HGD) and superficial submucosal invasive carcinoma (SM-s carcinoma), and Type 3 stands for deep submucosal invasive carcinoma (SM-d carcinoma). Although the diagnostic performance of JNET Type 2B is a little low, it enables characterization of the NICE Type 2 lesions and contributes to the selection of therapeutic procedures, such as piecemeal EMR, ESD, or surgery.

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