Szczesniak Michal M, Maclean Julia, O'Hare Joylene, Humbert Ianessa, Wu Peter I, Quon Harry, Graham Peter H, Cook Ian J
Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia St George Clinical School, University of New South Wales, Sydney, Australia
Speech Pathology Department, St George Hospital, Sydney, Australia.
Otolaryngol Head Neck Surg. 2016 Sep;155(3):462-5. doi: 10.1177/0194599816645270. Epub 2016 May 3.
Videofluoroscopy is the standard technique to evaluate dysphagia following radiotherapy for head and neck cancer (HNC). The accuracy of radiography in detecting strictures at the pharyngoesophageal junction is unknown. Our aim was to determine the diagnostic accuracy of videofluoroscopy in detecting strictures at the pharyngoesophageal junction prior to endoscopic dilatation in a consecutive series of HNC survivors with dysphagia. Presence of a stricture on videofluoroscopy was determined by 3 experienced blinded investigators and compared against a gold standard, defined as presence of a mucosal tear during endoscopic dilatation. In 10 of 33 patients, there was complete agreement among observers with respect to the presence or absence of a stricture. Overall, the concordance among observers in identification of strictures was very poor, with a kappa of 0.05 (P = .30). The diagnostic sensitivity and specificity of videofluoroscopy in detecting strictures was 0.76 and 0.58, respectively. Videofluoroscopy alone is inadequate to detect strictures in HNC survivors with dysphagia.
视频荧光吞咽造影是评估头颈部癌（HNC）放疗后吞咽困难的标准技术。X线摄影检测咽食管交界处狭窄的准确性尚不清楚。我们的目的是确定在一系列连续性吞咽困难的HNC幸存者中，视频荧光吞咽造影在内镜扩张术前检测咽食管交界处狭窄的诊断准确性。3名经验丰富的不知情调查人员确定视频荧光吞咽造影中狭窄的存在情况，并与金标准进行比较，金标准定义为内镜扩张时黏膜撕裂的存在。在33例患者中的10例中，观察者在狭窄存在与否方面完全一致。总体而言，观察者在狭窄识别方面的一致性非常差，kappa值为0.05（P = 0.30）。视频荧光吞咽造影检测狭窄的诊断敏感性和特异性分别为0.76和0.58。仅靠视频荧光吞咽造影不足以检测出吞咽困难的HNC幸存者中的狭窄。
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