根据当前的指南，仅推荐对食管鳞状上皮严重异形性 (SDA) 病变进行临床干预。然而，组织活检得出的组织病理学诊断可能会低估病变的严重程度。本研究纳入了一项人群筛查试验中初始细胞内染色镜检测时的1073名受试者，其中分析主要针对洛格不染色病变 (LULs) 的大小。结果以基线筛查时或随访期间发现的SDA病变定义为结果，统称累积SDA风险。采用多变量逻辑回归模型评估累积SDA风险。研究期间共识别到146例SDA病例。大型LULs的受试者在7年时间中累积发生SDA的发生率较高 (累积发生率16-20mm : 55.88%; 累积发生率>20mm : 76.92%)。大型LULs显著与更高的累积SDA风险相关，无论病理学诊断如何 (校正后OR16-20mmvs.≤5mm  = 21.02，95% CI: 7.56-58.47；校正后OR>20mmvs.≤5mm  = 33.62，95% CI: 11.79-95.87)。本研究结果表明，应针对食管中大于20 mm的LULs进行医患共同决策，确定是否进行临床治疗或密切监测。对于具有16-20 mm LULs的患者，应谨慎考虑密切监测。© 2023 The Authors. Cancer Medicine由John Wiley & Sons Ltd出版。

Current guidelines recommend only severe dysplasia and above (SDA) lesions of the esophageal squamous epithelium for clinical intervention. However, the histopathologic diagnosis derived from tissue biopsies may be subject to underestimation of severity.1073 participants from whom biopsies were taken at baseline chromoendoscopic examination in a population-based screening trial were enrolled in this study. The size of the Lugol-unstained lesions (LULs) was mainly analyzed. The outcome was defined as SDA lesions either identified at baseline screening, or during follow-up, collectively referred to as the cumulative risk of SDA. Multivariable logistic regression models were used to evaluate the cumulative risk of SDA.One hundred and forty-six SDA cases were identified in the study period. Participants with large LULs had a high cumulative incidence of SDA (cumulative incidence16-20mm : 55.88%; cumulative incidence>20mm : 76.92%) in the median of 7-year duration. LULs of large size were significantly associated with a higher cumulative risk of SDA, regardless of the pathologic diagnosis (adjusted OR16-20mmvs.≤5mm  = 21.02, 95% CI: 7.56-58.47; adjusted OR>20mmvs.≤5mm  = 33.62, 95% CI: 11.79-95.87).Results from this study suggest physician-patient shared decision-making regarding clinical treatment or intensive surveillance should be carried out for LULs >20 mm in the esophagus, regardless of the histologic diagnosis. For those with LULs of 16-20 mm, intensive surveillance would also best be considered.© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.