Krishna Priya, Bomze Laura, Watson Wayanne, Yang Sara, Crawley Brianna, Inman Jared C
Department of Otolaryngology - Head and Neck Surgery Loma Linda University Health Loma Linda California USA.
Loma Linda University School of Medicine Loma Linda California USA.
Laryngoscope Investig Otolaryngol. 2021 Jun 29;6(4):677-682. doi: 10.1002/lio2.493. eCollection 2021 Aug.
The primary goal of this study was to examine how well findings of cervical esophageal stenosis on modified barium swallow (MBS) and esophagram correlate with clinical improvement following dilation in patients with a history of head and neck (H&N) cancer.
A retrospective review was performed at an academic hospital. The study population included H&N cancer patients with a history of neck dissection surgery who underwent esophageal dilation from 2010 to2018. Pre and postdilation swallowing function was assessed. The Functional Outcomes Swallowing Scale (FOSS) and Functional Oral Intake Scale (FOIS) were used as outcome measures.
The 95 patients were included. All patients had imaging prior to dilation. Post-dilation FOSS and FOIS scores were significantly improved ( < .001). In identifying the patients that would have improvement from dilation, esophagram and MBS had average sensitivities of 81% and 82%, respectively. The negative predictive value (ie, the ability of a normal esophagram or normal MBS to exclude patients that would not improve with dilation) was only 46% and 38%, respectively. When the specific finding of aspiration on MBS was considered, the positive predictive value (PPV) (ie, the ability of an MBS positive for aspiration to predict that a patient would benefit from dilation) was 87% ( = .03). When only the specific finding of stenosis on esophagram was considered, the PPV of improvement post-dilation was 58% ( = .97). The delay in time from imaging to dilation was significantly longer in those who had an unidentified stenosis (false negative) on imaging when compared to those who did not (46.8 ± 35.2 days vs 312.6 ± 244.1 days, < .001).
In high risk patients for cervical esophageal stenosis, such as those with a history of H&N cancer and open neck surgery with or without radiation, MBS and esophagram appear to have mixed reliability as predictors of response to esophageal dilation. In these patients, a "negative" result on MBS and esophagram may not be diagnostically accurate enough to exclude patients from consideration of dilation.
IIb.
本研究的主要目的是探讨改良钡餐吞咽造影（MBS）和食管造影检查发现的颈段食管狭窄与头颈部（H&N）癌病史患者扩张术后临床改善情况的相关性。
在一家学术医院进行回顾性研究。研究人群包括2010年至2018年期间接受食管扩张术且有颈部清扫手术史的H&N癌患者。评估扩张术前和术后的吞咽功能。采用吞咽功能结局量表（FOSS）和功能性经口进食量表（FOIS）作为结局指标。
纳入95例患者。所有患者在扩张术前均进行了影像学检查。扩张术后FOSS和FOIS评分显著改善（P<0.001）。在识别扩张术后会改善的患者方面，食管造影和MBS的平均敏感度分别为81%和82%。阴性预测值（即正常食管造影或正常MBS排除扩张术后不会改善患者的能力）分别仅为46%和38%。当考虑MBS上的误吸这一特定发现时，阳性预测值（PPV）（即MBS误吸阳性预测患者将从扩张术中获益的能力）为87%（P=0.03）。当仅考虑食管造影上的狭窄这一特定发现时，扩张术后改善的PPV为58%（P=0.97）。与未出现影像学未识别狭窄（假阴性）的患者相比，出现影像学未识别狭窄（假阴性）的患者从影像学检查到扩张术的时间延迟显著更长（46.8±35.2天对312.6±244.1天，P<0.001）。
在颈段食管狭窄的高危患者中，如那些有H&N癌病史且接受过有或无放疗的开放性颈部手术的患者，MBS和食管造影作为食管扩张术反应预测指标的可靠性参差不齐。在这些患者中，MBS和食管造影的“阴性”结果在诊断上可能不够准确，不足以排除患者接受扩张术的考虑。
IIb级。
