Department of Gastroenterology, Hepatology and Clinical Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland; Department of Gastroenterological Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland.
Department of Head and Neck Cancer, Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Pol Arch Intern Med. 2023 Oct 26;133(10). doi: 10.20452/pamw.16462. Epub 2023 Mar 14.
To date, there is no established optimal method for endoscopic detection of esophageal squamous cell neoplasia in high‑risk individuals.
We aimed to compare the performance of narrow‑band imaging (NBI) and Lugol chromoendoscopy in screening for esophageal neoplasia among patients with a history of treatment for head and neck squamous cell cancer (HNSCC).
We randomly assigned 300 patients who had completed curative treatment for HNSCC at least 1 year prior to the inclusion to undergo either NBI or Lugol endoscopy (2:1 ratio). Following white‑light examination of the esophagus, the assigned imaging study was performed, and biopsies were taken from any suspicious lesions identified using NBI or Lugol chromoendoscopy. The primary end point was positive predictive value (PPV) of the biopsied lesion for a diagnosis of esophageal neoplasia (high‑grade intraepithelial neoplasia [HG‑IEN] or invasive esophageal squamous cell carcinoma [ESCC]). The secondary end points included the number of biopsied lesions, duration of esophagus examination, and endoscopy tolerance.
In 294 patients included in the final analysis (NBI, n = 204; Lugol chromoendoscopy, n = 90), we diagnosed 3 ESCCs (1.02%) and 2 HG‑IENs (0.68%). The PPV of NBI and Lugol chromoendoscopy in per‑lesion analysis was 7.69% (95% CI, 0.94%-25.1%) and 8.11% (95% CI, 1.7%-21.9%), respectively (P >0.99). NBI outperformed Lugol chromoendoscopy in terms of the rate of patients requiring biopsy (12.75% vs 41.11%; P = 0.003), duration of esophagus examination (3.5 min vs 5.15 min; P <0.001), and endoscopy tolerance assessed on the visual analog scale (25 mm vs 36.5 mm; P = 0.002).
With a PPV comparable to that of Lugol chromoendoscopy, but a lower number of biopsies required, shorter examination time, and better patient tolerance, NBI could be considered the primary screening method for ESCC in patients with HNSCC.
迄今为止，尚无针对高危人群的食管鳞状细胞癌内镜检测的最佳方法。
我们旨在比较窄带成像（NBI）和卢戈氏染色内镜在治疗头颈部鳞状细胞癌（HNSCC）后患者中的食管肿瘤筛查中的表现。
我们随机分配了 300 名在纳入前至少 1 年完成 HNSCC 根治性治疗的患者，他们接受 NBI 或卢戈氏内镜检查（2:1 比例）。在白光食管检查后，进行指定的成像研究，并使用 NBI 或卢戈氏染色内镜检查从任何可疑病变处进行活检。主要终点是活检病变诊断为食管肿瘤（高级别上皮内瘤变[HG-IN]或浸润性食管鳞状细胞癌[ESCC]）的阳性预测值（PPV）。次要终点包括活检病变的数量、食管检查的持续时间和内镜耐受性。
在最终分析的 294 名患者（NBI，n=204；卢戈氏染色内镜，n=90）中，我们诊断出 3 例 ESCC（1.02%）和 2 例 HG-IN（0.68%）。在每例病变的分析中，NBI 和卢戈氏染色内镜的 PPV 分别为 7.69%（95%CI，0.94%-25.1%）和 8.11%（95%CI，1.7%-21.9%）（P＞0.99）。NBI 在需要活检的患者比例（12.75% vs 41.11%；P=0.003）、食管检查持续时间（3.5 分钟 vs 5.15 分钟；P＜0.001）和视觉模拟量表评估的内镜耐受性（25 毫米 vs 36.5 毫米；P=0.002）方面均优于卢戈氏染色内镜。
NBI 的 PPV 与卢戈氏染色内镜相当，但所需活检的数量更少、检查时间更短、患者耐受性更好，因此可被视为 HNSCC 患者 ESCC 的主要筛查方法。
