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Ishihara R, Hikichi T, Iwaya Y, Iijima K, Imagawa A, Mabe K, Ito N, Suga T, Iizuka T, Nishida T, Furumoto Y, Muto M, Takeuchi H. Evaluating the discrepancies between evidence-based and community standard practices in the endoscopic diagnosis of esophageal squamous cell carcinoma: a survey study. Esophagus 2024:10.1007/s10388-024-01087-3. [PMID: 39313593 DOI: 10.1007/s10388-024-01087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 09/02/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND The practice of endoscopic diagnosis of esophageal squamous cell carcinoma (ESCC) often diverges from evidence-based standards due to various factors, including inadequate dissemination of evidence or a mismatch between evidence and real-world contexts. This survey aimed to identify discrepancies between evidence-based standard practices and community standard practices for ESCC among endoscopists. METHODS An online survey targeting endoscopists who perform upper gastrointestinal endoscopy at least weekly was conducted to collect data on clinical practices related to ESCC diagnosis. The survey, comprising 20 questions, was disseminated through multiple professional networks. Descriptive statistical analysis and logistic regression were performed to analyze the data. RESULTS Data from 819 endoscopists were included in the analyses. Notably, a significant proportion employed narrow-band imaging/blue-laser imaging over iodine staining, and preferences varied based on risk assessment for ESCC. In total, 64.0% of endoscopists primarily used iodine solution at a concentration of 1% or less, while 96.5% of endoscopists performed an observation of the oral cavity and the pharynx when conducting upper gastrointestinal endoscopies on individuals at high risk of ESCC. The surveillance interval for metachronous multiple ESCCs was most commonly every 6 months, followed by every 12 months. In addition, most physicians conducted surveillance of metastatic recurrence at 6-month intervals. CONCLUSIONS This survey highlights significant gaps between evidence-based and community standard practices in the endoscopic diagnosis of ESCC. These findings underscore the need for enhanced dissemination of evidence-based guidelines and consideration of real-world clinical contexts to bridge these gaps and optimize patient care.
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Affiliation(s)
- Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka City, Osaka, 541-8567, Japan.
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yugo Iwaya
- Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | | | - Katsuhiro Mabe
- Mabe Goryokaku Gastrointestinal Endoscopy Clinic, Gastroenterology, Hakodate, Japan
| | - Nobuhito Ito
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tomoaki Suga
- Department of Gastroenterology, Japanese Red Cross Society Suwa Hospital, Suwa, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Yohei Furumoto
- Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Manabu Muto
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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2
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van Tilburg L, van de Ven SEM, de Jonge PJF, de Graaf W, Spaander MCW, Nikkessen S, Hardillo JA, Sewnaik A, Monserez DA, Mast H, Keereweer S, Bruno MJ, Baatenburg de Jong RJ, Koch AD. Endoscopic screening of the upper gastrointestinal tract for second primary tumors in patients with head and neck cancer in a Western country. Endoscopy 2023; 55:981-990. [PMID: 37328150 PMCID: PMC10602659 DOI: 10.1055/a-2111-5935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patients with head and neck squamous cell carcinoma (HNSCC) can develop second primary tumors (SPTs) in the esophagus. Endoscopic screening could lead to detection of SPTs at early stages and improve survival. METHODS We performed a prospective endoscopic screening study in patients with curably treated HNSCC diagnosed between January 2017-July 2021 in a Western country. Screening was performed synchronously (< 6 months) or metachronously (≥ 6 months) after HNSCC diagnosis. Routine imaging for HNSCC consisted of flexible transnasal endoscopy with positron emission tomography/computed tomography or magnetic resonance imaging, depending on primary HNSCC location. The primary outcome was prevalence of SPTs, defined as presence of esophageal high grade dysplasia or squamous cell carcinoma. RESULTS 202 patients (mean age 65 years, 80.7 % male) underwent 250 screening endoscopies. HNSCC was located in the oropharynx (31.9 %), hypopharynx (26.9 %), larynx (22.2 %), and oral cavity (18.5 %). Endoscopic screening was performed within 6 months (34.0 %), 6 months to 1 year (8.0 %), 1-2 years (33.6 %), and 2-5 years (24.4 %) after HNSCC diagnosis. We detected 11 SPTs in 10 patients (5.0 %, 95 %CI 2.4 %-8.9 %) during synchronous (6/85) and metachronous (5/165) screening. Most patients had early stage SPTs (90 %) and were treated with curative intent with endoscopic resection (80 %). No SPTs in screened patients were detected with routine imaging for HNSCC before endoscopic screening. CONCLUSION In 5 % of patients with HNSCC, an SPT was detected with endoscopic screening. Endoscopic screening should be considered in selected HNSCC patients to detect early stage SPTs, based on highest SPT risk and life expectancy according to HNSCC and comorbidities.
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Affiliation(s)
- Laurelle van Tilburg
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Steffi E. M. van de Ven
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Pieter Jan F. de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Wilmar de Graaf
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Manon C. W. Spaander
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Suzan Nikkessen
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Jose A. Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Dominiek A. Monserez
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Hetty Mast
- Department of Oral and Maxillofacial Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Stijn Keereweer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Robert J. Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Arjun D. Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
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Chen YH, Ho CM, Wu MS, Hsu WH, Wang WYY, Yuan SSF, Hsieh HM, Wu IC. Effect of esophageal cancer screening on mortality among patients with oral cancer and second primary esophageal cancer in Taiwan. Am J Otolaryngol 2023; 44:103856. [PMID: 37062150 DOI: 10.1016/j.amjoto.2023.103856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/19/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Oral and esophageal cancer are the fourth and fifth leading causes of cancer deaths among men in Taiwan. Despite a good prognosis for oral cavity cancer patients, survival is worse for those who develop second primary esophageal cancer. There remains no consensus regarding early prevention of potential second primary esophageal cancer in patients with oral cavity cancer. Our study aimed to compare 5-year mortality between endoscopically screened and non-screened patients with oral cavity cancer and second primary esophageal cancer. MATERIALS AND METHODS This study identified patients with incident oral cavity cancer and second primary esophageal cancer during 2004 and 2013 using the Taiwan Cancer Registry and National Health Insurance Research Database. We compared 5-year mortality from the second primary esophageal cancer diagnosis date between screened and non-screened groups of patients with oral cavity cancer and second primary esophageal cancer. RESULTS A total of 217 screened and 305 non-screened oral cavity cancer patients with second primary esophageal cancer were studied. Endoscopic screening significantly improved early detection of second primary esophageal cancer (adjusted odds ratio: 0.34, 95 % confidence interval [CI]: 0.23-0.49) and reduced all-cause mortality (adjusted hazard ratio: 0.80; 95 % CI: 0.66-0.98). CONCLUSIONS Oral cavity cancer patients with second primary esophageal cancer may have worse overall survival than those without. Early detection of second primary esophageal cancer is a crucial mediator between endoscopic screening and mortality. Endoscopic screening after the diagnosis of incident oral cavity cancer significantly increased early detection and reduced all-cause mortality.
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Accuracy of narrow-band imaging in predicting the histology of anal intraepithelial lesions. Eur J Gastroenterol Hepatol 2023; 35:31-35. [PMID: 36468566 DOI: 10.1097/meg.0000000000002457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIM Anal intraepithelial neoplasia (AIN) is the precursor of anal squamous carcinoma, frequently underappreciated by most gastroenterologists. Purpose of the study is to assess the diagnostic accuracy of narrow-band imaging (NBI) in predicting the histology of anal lesions, considering a new NBI classification. METHODS This is a retrospective analysis of consecutive patients with suspected anal squamous intraepithelial lesions (SILs) and superficially invasive squamous cell carcinoma (SISCCA) who underwent anorectal-sigmoidoscopy. Three expert endoscopists reviewed all the images collected during colonoscopies in white light and NBI in order to generate a practical classification of three main different NBI patterns. RESULTS After the modified Delphi process, the final NBI classification, mainly based on intrapapillary capillary loops (IPCL) changes included three different NBI pattern. NBI pattern I: elongation of IPCL toward epithelial surface; NBI pattern 2: thickened and tortuous IPCL; NBI pattern 3: mosaic-like disposition of IPCL. We found that NBI pattern positively correlated to the histologic type of the lesions and tumor grade (Spearman's rho = 0.9671, P = 0.0000). Among 58 anal lesions included, 41/41 (100%) LSILs have been classified as NBI pattern I, 10/11 (90.91%) HSILs as NBI pattern II, 1/11 HSIL as NBI pattern I, 4/4 SISCCA as NBI pattern III and 2/2 invasive cancer as NBI pattern III. Diagnostic accuracy of NBI pattern II or III in predicting histology differentiating HSIL or SISCCA/IC versus LSIL showed a sensitivity of 100%, (95% CI: 92.3-100%) and a specificity of 94.1% (95% CI: 83.8-98.3%). CONCLUSION The accuracy of this new NBI score system in predicting the histology of anal lesions showed encouraging data in term of sensitivity and specificity in differentiating HSIL or SISCCA/IC versus LSIL, but the clinical usefulness and application of these findings should be evaluated in a prospective larger study.
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Meng QQ, Gao Y, Lin H, Wang TJ, Zhang YR, Feng J, Li ZS, Xin L, Wang LW. Application of an artificial intelligence system for endoscopic diagnosis of superficial esophageal squamous cell carcinoma. World J Gastroenterol 2022; 28:5483-5493. [PMID: 36312830 PMCID: PMC9611708 DOI: 10.3748/wjg.v28.i37.5483] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/09/2022] [Accepted: 09/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Upper gastrointestinal endoscopy is critical for esophageal squamous cell carcinoma (ESCC) detection; however, endoscopists require long-term training to avoid missing superficial lesions.
AIM To develop a deep learning computer-assisted diagnosis (CAD) system for endoscopic detection of superficial ESCC and investigate its application value.
METHODS We configured the CAD system for white-light and narrow-band imaging modes based on the YOLO v5 algorithm. A total of 4447 images from 837 patients and 1695 images from 323 patients were included in the training and testing datasets, respectively. Two experts and two non-expert endoscopists reviewed the testing dataset independently and with computer assistance. The diagnostic performance was evaluated in terms of the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity.
RESULTS The area under the receiver operating characteristics curve, accuracy, sensitivity, and specificity of the CAD system were 0.982 [95% confidence interval (CI): 0.969-0.994], 92.9% (95%CI: 89.5%-95.2%), 91.9% (95%CI: 87.4%-94.9%), and 94.7% (95%CI: 89.0%-97.6%), respectively. The accuracy of CAD was significantly higher than that of non-expert endoscopists (78.3%, P < 0.001 compared with CAD) and comparable to that of expert endoscopists (91.0%, P = 0.129 compared with CAD). After referring to the CAD results, the accuracy of the non-expert endoscopists significantly improved (88.2% vs 78.3%, P < 0.001). Lesions with Paris classification type 0-IIb were more likely to be inaccurately identified by the CAD system.
CONCLUSION The diagnostic performance of the CAD system is promising and may assist in improving detectability, particularly for inexperienced endoscopists.
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Affiliation(s)
- Qian-Qian Meng
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Ye Gao
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Han Lin
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Tian-Jiao Wang
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Yan-Rong Zhang
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Jian Feng
- Qingdao Medcare Digital Engineering Co. Ltd., Qingdao Medcare Digital Engineering Co. Ltd., Qingdao 26600, Shandong Province, China
| | - Zhao-Shen Li
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Lei Xin
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
| | - Luo-Wei Wang
- Department of Gastroenterology, Changhai Hospital, Shanghai 200433, China
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Kawai T, Kawai Y, Hamada M, Iwata E, Niikura R, Nagata N, Yanagisawa K, Sugimoto M, Fukuzawa M, Yamagishi T, Itoi T. Present status and the future of ultrathin endoscopy. Dig Endosc 2022; 34:1110-1120. [PMID: 35266224 DOI: 10.1111/den.14297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 02/08/2023]
Abstract
Endoscopic population-based screening for gastric cancer began in April 2016, and the use of transnasal ultrathin esophagogastroduodenoscopy (UT-EGD) has rapidly become popular. With UT-EGD, discomfort associated with an examination is reduced, patient satisfaction is high, and adverse effects on cardiopulmonary function are fewer. Consequently, UT-EGD is a good option for gastric screening in an aging society. Because of the narrower diameter of the endoscope, however, image quality is inferior to that obtained using transoral conventional esophagogastroduodenoscopy (C-EGD). As a result, lesions observed by UT-EGD must be viewed at close proximity and chromoendoscopy should be used concurrently, which is burdensome for the endoscopist. Recent innovations by endoscope manufacturers have enabled dramatic improvements in transnasal UT-EGD and facilitated Hi-Vision imaging. Furthermore, image enhancement that allows for observation on a par with transoral C-EGD is now feasible. In the future, UT-EGD will be equipped with functions that permit magnified endoscopic image. It is anticipated that a multiroute transition between transnasal and transoral UT-EGD will become possible.
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Affiliation(s)
- Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Mariko Hamada
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Eri Iwata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Ryota Niikura
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Naoyoshi Nagata
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Kyosuke Yanagisawa
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Mitsushige Sugimoto
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Masakatsu Fukuzawa
- Department of, Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
| | - Tetsuya Yamagishi
- Department of Gastroenterological Endoscopy, Tokyo Medical University, Tokyo, Japan
| | - Takao Itoi
- Department of, Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan
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Kuo CY, Wu JW, Yeh JH, Wang WL, Tu CH, Chiu HM, Liao WC. Implementing precision medicine in endoscopy practice. J Gastroenterol Hepatol 2022; 37:1455-1468. [PMID: 35778863 DOI: 10.1111/jgh.15933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
In contrast to the "one-size-fits-all" approach, precision medicine focuses on providing health care tailored to individual variabilities. Implementing precision medicine in endoscopy practice involves selecting the appropriate procedures among the endoscopic armamentarium in the diagnosis and management of patients in a logical sequence, jointly considering the pretest probabilities of possible diagnoses, patients' comorbidities and preference, and risk-benefit ratio of the individual procedures given the clinical scenario. The aim of this review is to summarize evidence-supported strategies and measures that may enhance precision medicine in general endoscopy practice.
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Affiliation(s)
- Chen-Ya Kuo
- Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Jer-Wei Wu
- Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Jen-Hao Yeh
- Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan
| | - Wen-Lun Wang
- Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chia-Hung Tu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wei-Chih Liao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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8
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Ho CM, Chen YH, Hsu WH, Wang WYY, Yuan SSF, Wu IC, Hsieh HM. Comparative effectiveness and stage-shift effect of endoscopic exam among newly diagnosed oral cancer patients with different stages in Taiwan. Head Neck 2022; 44:2118-2128. [PMID: 35751477 DOI: 10.1002/hed.27123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/20/2022] [Accepted: 06/01/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patients with oral cancer are at higher risk of developing second primary esophageal cancer (SPEC) and the consensus for screening strategies remains unclear. This study aimed to examine comparative effectiveness and the stage-shift effect of endoscopic exam among patients with oral cancer. METHOD A population-based longitudinal retrospective observational matched case and control cohort study with at least 5 years follow-up was conducted. We identified 45 457 newly diagnosed patients with oral cancer, 2004-2013, and the eligible patient with oral cancer was 39 401. Propensity score matching was used to match comparable groups, and the two groups (screening vs. nonscreening) was 5941, individually. The study primary endpoints were to compare detection of incident SPEC and the stage-shift effect of endoscopic screening between screened and nonscreened incident oral cancer patients. Cox proportional hazard and competing risk models were analyzed. Statistical analyses were conducted in 2020-2021. RESULT Detection of incident SPEC in the screened group was significantly higher than in the nonscreened group (hazard ratio: 2.92, 95% confidence interval [CI]: 2.29-3.72). The stage-shift effect from endoscopic screening was found overall in patients with oral cancer (odds ratio [OR]: 0.39, 95%CI: 0.21-0.70), in particular in advanced-stage patients (OR: 0.25, 95%CI: 0.11-0.61), but not in early-stage patients (OR: 0.60, 95%CI: 0.26-1.40). CONCLUSION This study confirmed that endoscopic screening achieved early detection of SPEC among patients with oral cancer. To improve the screening stage-shift effect, patients with oral cancer are encouraged to undergo routine endoscopic screening.
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Affiliation(s)
- Chi-Mei Ho
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hsun Chen
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Winnie Yen-Yun Wang
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shyng-Shiou F Yuan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Chen Wu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Community Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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9
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Sawaf T, Quereshy HA, Cabrera CI, Abrol A, Tamaki A, Thuener J, Li S. Incidence of synchronous malignancies found during triple endoscopy in head and neck cancer. Am J Otolaryngol 2022; 43:103349. [PMID: 34991020 DOI: 10.1016/j.amjoto.2021.103349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 12/13/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To investigate the incidence of synchronous malignancies identified during triple endoscopy in patients with head and neck squamous cell carcinoma. METHODS A retrospective chart review of patients from a tertiary academic medical center was performed. Patients with a primary head and neck squamous cell carcinoma who underwent triple endoscopy were included. Operative, radiographic, and pathology reports were reviewed to evaluate for the presence of synchronous malignancies in the aerodigestive tract diagnosed through endoscopy. Demographics, relevant medical history, including tobacco and alcohol use, and tumor characteristics were recorded. Univariate and multivariate regression analyses were conducted to assess for associations with synchronous malignancy on triple endoscopy. RESULTS 215 patients were reviewed, 164 of which had a biopsy-positive head and neck squamous cell carcinoma and underwent triple endoscopy. Synchronous lesions were found in 8 patients (4.9%). Of the synchronous lesions, only two were identified on esophagoscopy and bronchoscopy; the remaining six were found on direct laryngoscopy. Clinical comorbidities including smoking and alcohol history, tumor p16 status, and tumor stage were not associated with presence of synchronous lesions. A positive synchronous lesion on positron emission tomography was significantly correlated with finding a synchronous lesion on triple endoscopy (p = 0.006). CONCLUSION This study shows the incidence of synchronous lesions on triple endoscopy to be closer to 5%. While endoscopic examination can be useful in the anatomic characterization of head and neck malignancies, the low incidence of synchronous malignancies suggests that the need for triple endoscopy may be considered on a case-by-case basis.
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10
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Secondary primary malignancy in patients with head and neck squamous cell carcinoma: 27-year experience from the perspective of diagnostic tools. PLoS One 2022; 17:e0263773. [PMID: 35167611 PMCID: PMC8846538 DOI: 10.1371/journal.pone.0263773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 01/26/2022] [Indexed: 12/24/2022] Open
Abstract
Background
The survival rate of head and neck squamous cell carcinoma (HNSCC) patients with secondary primary malignancy (SPM) showed no significant improvement for decades, however, the impact of advances in diagnostic tools is rarely mentioned. This study investigated the clinical characteristic of HNSCC with SPM over a 27-year period especially from the perspective of diagnostic tools.
Methods
This study evaluated 157 HNSCC patients with SPM. The patients were divided into two groups according to the time of SPM diagnosis (Group A:1992–2003; Group B: 2004–2014). Age, gender, stage of first primary malignancy (FPM), SPM interval, overall survival, and disease-free survival were compared between groups.
Results
Group B had significantly more SPM developed rate (p = 0.002), more SPM patients with advanced stage of FPM (p = 0.001), synchronous SPM (p = 0.006), and shorter SPM interval (p<0.001) compared to Group A. The survival rate in Group B was not significantly better than Group A.
Conclusion
Among patients diagnosed with HNSCC recently, more SPMs are diagnosed in a shorter time interval and in a more advanced stage. The overall advances in diagnostic tools cannot significantly improve SPM survival, however, it enables more patients to receive corresponding treatment.
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11
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Nobre Moura R, Kuboki Y, Baba ER, Safatle-Ribeiro A, Martins B, de Paulo GA, Tolentino LL, de Lima MS, Kulcsar MA, Sallum RAA, Ribeiro U, Maluf-Filho F. Long-term results of an endoscopic screening program for superficial esophageal cancer in patients with head and neck squamous cell carcinoma. Endosc Int Open 2022; 10:E200-E208. [PMID: 35178338 PMCID: PMC8847053 DOI: 10.1055/a-1675-2334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/07/2021] [Indexed: 11/01/2022] Open
Abstract
Background and study aims Patients with head and neck squamous cell carcinoma (HNSCC) are at risk of a second primary tumor in the gastrointestinal tract, most commonly in the esophagus. Screening these patients for esophageal carcinoma may help detect asymptomatic dysplasia and early cancer, thus allowing curative treatment and more prolonged survival, but the impact of endoscopic screening remains uncertain. Here we aimed to describe the long-term results of an esophageal SCC screening program in patients with head and neck cancer in terms of prevalence, associated risk factors, and survival. Patients and methods We performed an observational study of a prospectively collected database including patients with HNSCC who had undergone high-definition endoscopy with chromoscopy between 2010 and 2018 at a Brazilian tertiary academic center. Results The study included 1,888 patients. The esophageal SCC prevalence was 7.9 %, with the majority (77.8 %) being superficial lesions. Significant risk factors for esophageal high-grade dysplasia (HGD) and invasive cancer included tumors of the oral cavity and oropharynx and the presence of low-grade dysplasia (LGD). Overall survival (OS) was significantly shorter among patients in whom esophageal cancer was diagnosed at an advanced stage ( P < .001). OS did not significantly differ between patients with HGD and early esophageal cancer versus those without esophageal cancer ( P = .210) Conclusions Endoscopic screening for superficial esophageal neoplasia in patients with HNSCC improves esophageal cancer detection. Screening could potentially benefit patients with primary cancer located at the oropharynx or oral cavity. In addition, the detection of esophageal LGD indicates a need for endoscopic surveillance.
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Affiliation(s)
- Renata Nobre Moura
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Yeda Kuboki
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Elisa Ryoka Baba
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Adriana Safatle-Ribeiro
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Bruno Martins
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gustavo Andrade de Paulo
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Luciano Lenz Tolentino
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Simas de Lima
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marco Aurelio Kulcsar
- Discipline of Head and Neck Surgery, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rubens Antonio Aissar Sallum
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ulysses Ribeiro
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Fauze Maluf-Filho
- Department of Gastroenterology, Instituto do Cancer (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil,Laboratorio de Investigacao Medica, LIM-37, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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12
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Luo X, Huang X, Liu S, Wang X, Luo J, Xiao J, Wang K, Qu Y, Chen X, Zhang Y, Wang J, Zhang J, Xu G, Gao L, Wu R, Yi J. Evaluation of the prevalence of metachronous second primary malignancies in hypopharyngeal carcinoma and their effect on outcomes. Cancer Med 2022; 11:1059-1067. [PMID: 35080148 PMCID: PMC8855899 DOI: 10.1002/cam4.4501] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/06/2021] [Accepted: 11/26/2021] [Indexed: 01/08/2023] Open
Abstract
Background To investigate the clinical characteristics of metachronous second primary malignancies (Met‐SPMs) and its impact on prognosis in hypopharyngeal carcinoma (HPC). Methods We reviewed 593 newly diagnosed HPC patients without invasive synchronous SPMs (Syn‐SPMs) who were treated in our cancer center between 2009 and 2019. According to the status during follow‐up, patients were classified into three groups: (a) without SPMs (No‐SPMs, n = 440), (b) with tumors in situ in the esophagus or stomach (Tis, n = 80), or (c) with Met‐SPMs (n = 73). Results The median follow‐up time for entire cohort (n = 593) was 66.7 months. Met‐SPMs were present in 12.3% of the cohort (73/593). The predominant site of SPMs was esophagus, followed by lung, oral cavity, thyroid, stomach, and oropharynx. In Met‐SPMs group, both index tumor and SPMs were the main causes of death. Tis group exhibited comparable 5‐year overall survival (OS) and disease‐specific survival (DSS) with that of No‐SPMs group. The Met‐SPMs group had similar 5‐year OS rate and better 5‐year DSS rate of 47.3% versus 43.6% (odds ratio [OR], 0.931; 95% confidence interval [CI], 0.681–1.274, p = 0.657) and 66.3% vs. 46.2% (OR, 0.600; 95% CI, 0.402–0.896, p = 0.012), respectively, compared with the No‐SPMs group. Conclusion The overall incidence of Met‐SPMs in HPC was 12.3%. The occurrence of Met‐SPMs does not jeopardize the survival outcome of HPC. Routine surveillance of Met‐SPMs was requisite for patients with HPC.
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Affiliation(s)
- Xi Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaodong Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaolei Wang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingwei Luo
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianping Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kai Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Qu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuesong Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingbo Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianghu Zhang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guozhen Xu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Gao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runye Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Yi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kawada K, Arima M, Miyahara R, Tsunomiya M, Kikuchi M, Yamamoto F, Hoshino A, Nakajima Y, Kinugasa Y, Kawano T. Effect of adding magnifying BLI, magnifying NBI, and iodine staining to white light imaging in diagnosis of early esophageal cancer. Endosc Int Open 2021; 9:E1877-E1885. [PMID: 34917456 PMCID: PMC8670998 DOI: 10.1055/a-1583-9196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
Background and study aims We investigated the effect of adding magnifying blue laser imaging (BLI), magnifying narrow-band imaging (NBI), and iodine staining to white light imaging in diagnosis of early esophageal squamous cell carcinoma (EESCC) in high-risk patients. Patients and methods Between May 2013 and March 2016, two parallel prospective cohorts of patients received either primary WLI followed by NBI-magnifying endoscopy (ME) or primary WLI followed by BLI-ME, were studied. At the end of screening, both groups underwent iodine staining. The percentage of patients with newly detected esophageal malignant lesions in each group and the diagnostic ability of image-enhanced endoscopy (IEE)-ME were evaluated. Results There are 258 patients assigned to the NBI-ME group and 254 patients assigned to the BLI-ME group. The percentage of patients with one or more malignant lesions detected in the WLI + NBI-ME examination was similar in the WLI + BLI-ME examination (15 of 258 patients or 5.81 % vs. 14 of 254 patients or 5.51 %). However, four of 19 lesions in the NBI-ME group and six of 21 lesions in the BLI-ME group were overlooked and were detected by iodine staining. NBI-ME and BLI-ME showed similar accuracy in differentiation of cancerous lesions from non-cancerous lesions in diagnosis of EESCC (NBI/BLI: sensitivity, 87.5/89.5; specificity, 78.9/76.6; accuracy, 80.8/79.5; positive predictive value, 53.8/53.1; negative predictive value, 95.7/96.1). Conclusions Both NBI and BLI were useful for detection of EESCC. However, because some lesions were overlooked by even NBI and BLI, high-risk patients may benefit from use of iodine staining during endoscopic screening of EESCC (UMIN000023596).
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Affiliation(s)
- Kenro Kawada
- Tokyo Medical and Dental University, Department of Gastrointestinal Surgery, Tokyo, Japan, Saitama Cancer center, Department of Gastroenterology
| | - Miwako Arima
- Saitama Cancer center, Department of Gastroenterology, Ina-machi, Kitaadachi, Japan
| | - Ryoji Miyahara
- Nagoya University Graduate School of Medicine, Department of Gastroenterology and Hepatology, Nagoya, Japan
| | - Mika Tsunomiya
- Saitama Cancer center, Department of Gastroenterology, Ina-machi, Kitaadachi, Japan
| | - Masakazu Kikuchi
- Nagoya University Graduate School of Medicine, Department of Gastroenterology and Hepatology, Nagoya, Japan
| | - Fumiko Yamamoto
- Nagoya University Graduate School of Medicine, Department of Gastroenterology and Hepatology, Nagoya, Japan
| | - Akihiro Hoshino
- Tokyo Medical and Dental University, Department of Gastrointestinal Surgery, Tokyo, Japan, Saitama Cancer center, Department of Gastroenterology
| | - Yasuaki Nakajima
- Tokyo Medical and Dental University, Department of Gastrointestinal Surgery, Tokyo, Japan, Saitama Cancer center, Department of Gastroenterology
| | - Yusuke Kinugasa
- Tokyo Medical and Dental University, Department of Gastrointestinal Surgery, Tokyo, Japan, Saitama Cancer center, Department of Gastroenterology
| | - Tatsuyuki Kawano
- Soka Municipal hospital, Department of Surgery, Soka city, Saitama, Japan
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14
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Huang YW, Wang YP, Lee TL, Chang CF, Hou MC, Tai SK, Chu PY. Image-enhanced endoscopy for detection of second primary esophageal neoplasms in patients with hypopharyngeal cancer: Prevalence, risk factors, and characteristics. J Chin Med Assoc 2021; 84:963-968. [PMID: 34320514 DOI: 10.1097/jcma.0000000000000592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Esophageal second primary neoplasms (ESPNs) are common in hypopharyngeal squamous cell carcinoma (HPSCC) patients and are associated with poor prognoses. The effectiveness of image-enhanced endoscopy (IEE) has not been well established. METHODS We reviewed the patients between April 2016 and April 2018 with HPSCC receiving ESPNs screening via white-light imaging, narrow-band imaging, and Lugol chromoendoscopy. RESULTS Of 99 eligible patients, ESPNs prevalence was 31%. Of the 69 patients assigned to the follow-up group, 23 with positive findings showed significantly increased previous histories of second primary malignancies in the upper aerodigestive tract. Among them, patients without symptoms at the time of IEE screening showed less advanced T stages and higher percentages of receiving minimal invasive therapy. CONCLUSION The present study represented the clinical utility of routine IEE screening in HPSCC patients and proposed routine surveillance may help identify and properly manage early-stage ESPN.
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Affiliation(s)
- Yu-Wen Huang
- Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Po Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tsung-Lun Lee
- Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Fan Chang
- Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shyh-Kuan Tai
- Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Pen-Yuan Chu
- Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Lakshminarasimman P, Pai PS, Mehta S, Patil P. Is Direct Laryngoscopy Obsolete? "Trans Nasal Oesophagoscopy" the Complete Endoscopic Solution in Head Neck Practice. Indian J Otolaryngol Head Neck Surg 2021; 73:310-314. [PMID: 34471618 DOI: 10.1007/s12070-021-02368-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
Direct laryngoscopy (DL) is the standard of care for the evaluation of suspicious lesions in the larynx and hypo pharynx but requires general anaesthesia and a dedicated operation theatre. While DL offers us the ability to map the lesion adequately and take a biopsy, it requires workup for anaesthesia well as rigid oesophagoscopy for assessing the oesophagus with its associated complications. Sixty-nine patients underwent TNE under topical anaesthesia. The lesions were mapped and biopsies taken. Those patients who had an inadequate evaluation on TNE or negative biopsy underwent direct laryngoscopy. Completeness of evaluation, adequacy of biopsy, presence of synchronous oesophageal lesions and the modified Gloucester Comfort Score for patient comfort was documented. Amongst 69 cases enrolled for TNE evaluation, 97% of cases had an adequate mapping of disease extent, and 100% adequacy of biopsy material. General anaesthesia could be avoided in 92.75% of patients. TNE took a median time of 8 min. Synchronous oesophageal tumours were seen in 5.8% of patients. There were no complications and 74% patients did not experience any discomfort. TNE appears to be simple, safe, efficient office based diagnostic procedure. TNE has the potential to be the new standard of care making DL obsolete.
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Affiliation(s)
- P Lakshminarasimman
- Department of Head and Neck Surgery (Surgical Oncology), Sri Ramachandra Medical College and Research Institute, No. 1, Ramachandra Nagar, Porur, Chennai, 600116 India
| | - Prathamesh S Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Shaesta Mehta
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Dr. E. Borges Road, Parel, Mumbai, 400012 India
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Chiam KH, Shin SH, Choi KC, Leiria F, Militz M, Singh R. Current Status of Mucosal Imaging with Narrow-Band Imaging in the Esophagus. Gut Liver 2021; 15:492-499. [PMID: 32307976 PMCID: PMC8283285 DOI: 10.5009/gnl20031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 12/13/2022] Open
Abstract
Recent advances in endoscopic imaging of the esophagus have revolutionized the diagnostic capability for detecting premalignant changes and early esophageal malignancy. In this article, we review the practical application of narrow-band imaging focusing on diseases of the esophagus, including Barrett's esophagus, adenocarcinoma, and squamous cell carcinoma.
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Affiliation(s)
- Keng Hoong Chiam
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Seon Ho Shin
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Kun Cheong Choi
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Florencia Leiria
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Mariana Militz
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin Hospital, Elizabeth Vale, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
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Ability of artificial intelligence to detect T1 esophageal squamous cell carcinoma from endoscopic videos and the effects of real-time assistance. Sci Rep 2021; 11:7759. [PMID: 33833355 PMCID: PMC8032773 DOI: 10.1038/s41598-021-87405-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
Diagnosis using artificial intelligence (AI) with deep learning could be useful in endoscopic examinations. We investigated the ability of AI to detect superficial esophageal squamous cell carcinoma (ESCC) from esophagogastroduodenoscopy (EGD) videos. We retrospectively collected 8428 EGD images of esophageal cancer to develop a convolutional neural network through deep learning. We evaluated the detection accuracy of the AI diagnosing system compared with that of 18 endoscopists. We used 144 EGD videos for the two validation sets. First, we used 64 EGD observation videos of ESCCs using both white light imaging (WLI) and narrow-band imaging (NBI). We then evaluated the system using 80 EGD videos from 40 patients (20 with superficial ESCC and 20 with non-ESCC). In the first set, the AI system correctly diagnosed 100% ESCCs. In the second set, it correctly detected 85% (17/20) ESCCs. Of these, 75% (15/20) and 55% (11/22) were detected by WLI and NBI, respectively, and the positive predictive value was 36.7%. The endoscopists correctly detected 45% (25–70%) ESCCs. With AI real-time assistance, the sensitivities of the endoscopists were significantly improved without AI assistance (p < 0.05). AI can detect superficial ESCCs from EGD videos with high sensitivity and the sensitivity of the endoscopist was improved with AI real-time support.
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Li B, Cai SL, Tan WM, Li JC, Yalikong A, Feng XS, Yu HH, Lu PX, Feng Z, Yao LQ, Zhou PH, Yan B, Zhong YS. Comparative study on artificial intelligence systems for detecting early esophageal squamous cell carcinoma between narrow-band and white-light imaging. World J Gastroenterol 2021; 27:281-293. [PMID: 33519142 PMCID: PMC7814365 DOI: 10.3748/wjg.v27.i3.281] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/05/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-magnifying endoscopy with narrow-band imaging (NM-NBI) has been frequently used in routine screening of esophagus squamous cell carcinoma (ESCC). The performance of NBI for screening of early ESCC is, however, significantly affected by operator experience. Artificial intelligence may be a unique approach to compensate for the lack of operator experience.
AIM To construct a computer-aided detection (CAD) system for application in NM-NBI to identify early ESCC and to compare it with our previously reported CAD system with endoscopic white-light imaging (WLI).
METHODS A total of 2167 abnormal NM-NBI images of early ESCC and 2568 normal images were collected from three institutions (Zhongshan Hospital of Fudan University, Xuhui Hospital, and Kiang Wu Hospital) as the training dataset, and 316 pairs of images, each pair including images obtained by WLI and NBI (same part), were collected for validation. Twenty endoscopists participated in this study to review the validation images with or without the assistance of the CAD systems. The diagnostic results of the two CAD systems and improvement in diagnostic efficacy of endoscopists were compared in terms of sensitivity, specificity, accuracy, positive predictive value, and negative predictive value.
RESULTS The area under receiver operating characteristic curve for CAD-NBI was 0.9761. For the validation dataset, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CAD-NBI were 91.0%, 96.7%, 94.3%, 95.3%, and 93.6%, respectively, while those of CAD-WLI were 98.5%, 83.1%, 89.5%, 80.8%, and 98.7%, respectively. CAD-NBI showed superior accuracy and specificity than CAD-WLI (P = 0.028 and P ≤ 0.001, respectively), while CAD-WLI had higher sensitivity than CAD-NBI (P = 0.006). By using both CAD-WLI and CAD-NBI, the endoscopists could improve their diagnostic efficacy to the highest level, with accuracy, sensitivity, and specificity of 94.9%, 92.4%, and 96.7%, respectively.
CONCLUSION The CAD-NBI system for screening early ESCC has higher accuracy and specificity than CAD-WLI. Endoscopists can achieve the best diagnostic efficacy using both CAD-WLI and CAD-NBI.
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Affiliation(s)
- Bing Li
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Shi-Lun Cai
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Wei-Min Tan
- School of Computer Science, Fudan University, Shanghai 200433, China
| | - Ji-Chun Li
- School of Computer Science, Fudan University, Shanghai 200433, China
| | - Ayimukedisi Yalikong
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Xiao-Shuang Feng
- Clinical Statistical Center, Shanghai Cancer Center of Fudan University, Shanghai 200032, China
| | - Hon-Ho Yu
- Department of Gastroenterology, Kiang Wu Hospital, Macau SAR 999078, China
| | - Pin-Xiang Lu
- Department of Endoscopy Center, Xuhui Hospital, Zhongshan Hospital of Fudan University, Shanghai 200031, China
| | - Zhen Feng
- Department of Endoscopy Center, Xuhui Hospital, Zhongshan Hospital of Fudan University, Shanghai 200031, China
| | - Li-Qing Yao
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Ping-Hong Zhou
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Bo Yan
- School of Computer Science, Fudan University, Shanghai 200433, China
| | - Yun-Shi Zhong
- Department of Endoscopy Center, Zhongshan Hospital of Fudan University, Shanghai 200032, China
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Suzuki H, Yoshitaka T, Yoshio T, Tada T. Artificial intelligence for cancer detection of the upper gastrointestinal tract. Dig Endosc 2021; 33:254-262. [PMID: 33222330 DOI: 10.1111/den.13897] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/16/2020] [Indexed: 12/20/2022]
Abstract
In recent years, artificial intelligence (AI) has been found to be useful to physicians in the field of image recognition due to three elements: deep learning (that is, CNN, convolutional neural network), a high-performance computer, and a large amount of digitized data. In the field of gastrointestinal endoscopy, Japanese endoscopists have produced the world's first achievements of CNN-based AI system for detecting gastric and esophageal cancers. This study reviews papers on CNN-based AI for gastrointestinal cancers, and discusses the future of this technology in clinical practice. Employing AI-based endoscopes would enable early cancer detection. The better diagnostic abilities of AI technology may be beneficial in early gastrointestinal cancers in which endoscopists have variable diagnostic abilities and accuracy. AI coupled with the expertise of endoscopists would increase the accuracy of endoscopic diagnosis.
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Affiliation(s)
- Hideo Suzuki
- Department of Gastroenterology, Graduate School of Institute Clinical Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tokai Yoshitaka
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tada
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,AI Medical Service Inc., Tokyo, Japan.,Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
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Sinonquel P, Eelbode T, Bossuyt P, Maes F, Bisschops R. Artificial intelligence and its impact on quality improvement in upper and lower gastrointestinal endoscopy. Dig Endosc 2021; 33:242-253. [PMID: 33145847 DOI: 10.1111/den.13888] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 12/24/2022]
Abstract
Artificial intelligence (AI) and its application in medicine has grown large interest. Within gastrointestinal (GI) endoscopy, the field of colonoscopy and polyp detection is the most investigated, however, upper GI follows the lead. Since endoscopy is performed by humans, it is inherently an imperfect procedure. Computer-aided diagnosis may improve its quality by helping prevent missing lesions and supporting optical diagnosis for those detected. An entire evolution in AI systems has been established in the last decades, resulting in optimization of the diagnostic performance with lower variability and matching or even outperformance of expert endoscopists. This shows a great potential for future quality improvement of endoscopy, given the outstanding diagnostic features of AI. With this narrative review, we highlight the potential benefit of AI to improve overall quality in daily endoscopy and describe the most recent developments for characterization and diagnosis as well as the recent conditions for regulatory approval.
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Affiliation(s)
- Pieter Sinonquel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Departments of, Department of, Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
| | - Tom Eelbode
- Medical Imaging Research Center (MIRC), University Hospitals Leuven, Leuven, Belgium.,Department of Electrical Engineering (ESAT/PSI), KU Leuven, Leuven, Belgium
| | - Peter Bossuyt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Department of Gastroenterology and Hepatology, Imelda Hospital, Bonheiden, Belgium
| | - Frederik Maes
- Medical Imaging Research Center (MIRC), University Hospitals Leuven, Leuven, Belgium.,Department of Electrical Engineering (ESAT/PSI), KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium.,Departments of, Department of, Translational Research in Gastrointestinal Diseases (TARGID), KU Leuven, Leuven, Belgium
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21
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Namikawa K, Hirasawa T, Yoshio T, Fujisaki J, Ozawa T, Ishihara S, Aoki T, Yamada A, Koike K, Suzuki H, Tada T. Utilizing artificial intelligence in endoscopy: a clinician's guide. Expert Rev Gastroenterol Hepatol 2020; 14:689-706. [PMID: 32500760 DOI: 10.1080/17474124.2020.1779058] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) that surpasses human ability in image recognition is expected to be applied in the field of gastrointestinal endoscopes. Accordingly, its research and development (R &D) is being actively conducted. With the development of endoscopic diagnosis, there is a shortage of specialists who can perform high-precision endoscopy. We will examine whether AI with excellent image recognition ability can overcome this problem. AREAS COVERED Since 2016, papers on artificial intelligence using convolutional neural network (CNN in other word Deep Learning) have been published. CNN is generally capable of more accurate detection and classification than conventional machine learning. This is a review of papers using CNN in the gastrointestinal endoscopy area, along with the reasons why AI is required in clinical practice. We divided this review into four parts: stomach, esophagus, large intestine, and capsule endoscope (small intestine). EXPERT OPINION Potential applications for the AI include colorectal polyp detection and differentiation, gastric and esophageal cancer detection, and lesion detection in capsule endoscopy. The accuracy of endoscopic diagnosis will increase if the AI and endoscopist perform the endoscopy together.
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Affiliation(s)
- Ken Namikawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo, Japan
| | - Tsuyoshi Ozawa
- Department of Surgery, Teikyo University School of Medicine , Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Tomonori Aoki
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Atsuo Yamada
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan
| | - Hideo Suzuki
- Department of Gastroenterology, Graduate School of Institute Clinical Medicine, University of Tsukuba , Ibaraki, Japan
| | - Tomohiro Tada
- Department of Surgical Oncology, Graduate School of Medicine, the University of Tokyo , Tokyo, Japan.,AI Medical Service Inc ., Tokyo, Japan.,Tada Tomohiro the Institute of Gastroenterology and Proctology , Saitama, Japan
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22
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Zhang R, Lau LHS, Wu PIC, Yip HC, Wong SH. Endoscopic Diagnosis and Treatment of Esophageal Squamous Cell Carcinoma. Methods Mol Biol 2020; 2129:47-62. [PMID: 32056169 DOI: 10.1007/978-1-0716-0377-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Esophageal squamous cell carcinoma (ESCC) is a deadly disease, partly because it is often diagnosed late in disease stage. An accurate early diagnosis by endoscopy could detect advanced carcinoma as well as curable dysplasia and early ESCC. This could save patients from incurable advanced malignancy. Important progress has been made in high-quality endoscopic diagnosis, including magnifying endoscopy, narrowband imaging, and other image enhancement, as well as in techniques in endoscopic resection. These emerging techniques will aid the early diagnosis of ESCC that lead to higher chance of curing the cancer.
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Affiliation(s)
- Ru Zhang
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Division of Gastroenterology, Department of Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Louis H S Lau
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Peter I C Wu
- Department of Gastroenterology and Hepatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Hon-Chi Yip
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Sunny H Wong
- Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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23
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Su WWY, Chuang SL, Yen AMF, Chen SLS, Fann JCY, Chiu SYH, Chiu HM, Su CW, Hsu CY, Chen MK, Chen HH, Wang CP, Lee YC. Risk for a second primary hypopharyngeal and esophageal cancer after an initial primary oral cancer. Oral Dis 2019; 25:1067-1075. [PMID: 30821883 DOI: 10.1111/odi.13080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/12/2019] [Accepted: 02/26/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the risk for second primary cancer in the hypopharynx and esophagus (SPC-HE) among individuals with an initial oral/oropharyngeal cancer. MATERIALS AND METHODS Mass screening data from Taiwan (2004-2009) included individuals who were ≥18 years old and smoked cigarettes and/or chewed betel quid. Occurrence of SPC-HE was monitored until December 31, 2014. Results were expressed as adjusted relative risk (aRR) and 95% confidence interval (CI). RESULTS One hundred and fifty-eight out of 4,494 subjects with oral cancer developed SPC-HE (incidence rate: 6.47 per 1,000 person-years). Relative to patients with primary cancers in the lip, the risk of an SPC-HE was higher in patients with primary cancers in oropharynx (aRR: 19.98, 95% CI: 4.72-84.55), floor of mouth (aRR: 12.13, 95% CI: 2.67-55.15), and hard palate (aRR: 7.31, 95% CI: 1.65-32.37), but not in patients with cancers in tongue (aRR: 3.67, 95% CI: 0.89-15.17) or gum (aRR: 3.99, 95% CI: 0.92-17.35). Regression analyses also showed the risk of an SPC-HE was greater in alcohol drinkers than those who did not (aRR: 1.65, 95% CI: 1.10-2.48). CONCLUSIONS Compared with the initial cancer in the lip, patients with a cancer in the oropharynx, floor of mouth, and hard palate had a higher risk for the SPC-HE.
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Affiliation(s)
- William Wang-Yu Su
- Division of Otorhinolaryngology- Head & Neck Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Shu-Lin Chuang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jean Ching-Yuan Fann
- Department and Graduate Institute of Health Care Management, Kainan University, Tao-Yuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan.,Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Han-Mo Chiu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chiu-Wen Su
- Big Data Research Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Chen-Yang Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Mu-Kuan Chen
- Department of Otolaryngology- Head & Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Cheng-Ping Wang
- Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chia Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
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24
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Bugter O, van Iwaarden DLP, Dronkers EAC, de Herdt MJ, Wieringa MH, Verduijn GM, Mureau MAM, Ten Hove I, van Meerten E, Hardillo JA, Baatenburg de Jong RJ. Survival of patients with head and neck cancer with metachronous multiple primary tumors is surprisingly favorable. Head Neck 2019; 41:1648-1655. [PMID: 30652377 PMCID: PMC6590295 DOI: 10.1002/hed.25595] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/24/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background The objectives of this study are to determine the incidence and survival rate of patients with head and neck squamous cell carcinoma (HNSCC) with multiple primary tumors (MPT) in the HN‐region, lung, or esophagus. Methods Patient and tumor specific data of 1372 patients with HNSCC were collected from both the national cancer registry and patient records to ensure high‐quality double‐checked data. Results The total incidence of MPTs in the HN‐region, lung, and esophagus in patients with HNSCC was 11% (149/1372). Patients with lung MPTs and esophageal MPTs had a significant worse 5‐year survival than patients with HN‐MPTs (29%, 14%, and 67%, respectively, P < 0.001). The 5‐year survival rate for synchronous HN MPTs was only 25%, whereas it was surprisingly high for patients with metachronous HN MPT (85%, P < 0.001). Conclusions One of 10 patients with HNSCC develop MPTs in the HN‐region, lung, or esophagus. The 5‐year survival of patients with metachronous HN MPTs was surprisingly favorable.
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Affiliation(s)
- Oisín Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dirk L P van Iwaarden
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martine J de Herdt
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marjan H Wieringa
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Gerda M Verduijn
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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25
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Horie Y, Yoshio T, Aoyama K, Yoshimizu S, Horiuchi Y, Ishiyama A, Hirasawa T, Tsuchida T, Ozawa T, Ishihara S, Kumagai Y, Fujishiro M, Maetani I, Fujisaki J, Tada T. Diagnostic outcomes of esophageal cancer by artificial intelligence using convolutional neural networks. Gastrointest Endosc 2019; 89:25-32. [PMID: 30120958 DOI: 10.1016/j.gie.2018.07.037] [Citation(s) in RCA: 235] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/29/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS The prognosis of esophageal cancer is relatively poor. Patients are usually diagnosed at an advanced stage when it is often too late for effective treatment. Recently, artificial intelligence (AI) using deep learning has made remarkable progress in medicine. However, there are no reports on its application for diagnosing esophageal cancer. Here, we demonstrate the diagnostic ability of AI to detect esophageal cancer including squamous cell carcinoma and adenocarcinoma. METHODS We retrospectively collected 8428 training images of esophageal cancer from 384 patients at the Cancer Institute Hospital, Japan. Using these, we developed deep learning through convolutional neural networks (CNNs). We also prepared 1118 test images for 47 patients with 49 esophageal cancers and 50 patients without esophageal cancer to evaluate the diagnostic accuracy. RESULTS The CNN took 27 seconds to analyze 1118 test images and correctly detected esophageal cancer cases with a sensitivity of 98%. CNN could detect all 7 small cancer lesions less than 10 mm in size. Although the positive predictive value for each image was 40%, misdiagnosing shadows and normal structures led to a negative predictive value of 95%. The CNN could distinguish superficial esophageal cancer from advanced cancer with an accuracy of 98%. CONCLUSIONS The constructed CNN system for detecting esophageal cancer can analyze stored endoscopic images in a short time with high sensitivity. However, more training would lead to higher diagnostic accuracy. This system can facilitate early detection in practice, leading to a better prognosis in the near future.
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Affiliation(s)
- Yoshimasa Horie
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| | | | - Shoichi Yoshimizu
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yusuke Horiuchi
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiaki Hirasawa
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan; Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Ozawa
- Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan; Surgery Department, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Soichiro Ishihara
- Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan; Surgery Department, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Youichi Kumagai
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Iruru Maetani
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Junko Fujisaki
- Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tada
- Tada Tomohiro Institute of Gastroenterology and Proctology, Saitama, Japan; AI Medical Service Inc, Tokyo, Japan; Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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26
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Bugter O, van de Ven SEM, Hardillo JA, Bruno MJ, Koch AD, Baatenburg de Jong RJ. Early detection of esophageal second primary tumors using Lugol chromoendoscopy in patients with head and neck cancer: A systematic review and meta-analysis. Head Neck 2018; 41:1122-1130. [PMID: 30593712 PMCID: PMC6590301 DOI: 10.1002/hed.25548] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/09/2018] [Accepted: 11/08/2018] [Indexed: 12/19/2022] Open
Abstract
Background Early detection of esophageal secondary primary tumors (SPTs) in head and neck squamous cell carcinoma (HNSCC) patients could increase patient survival. The purpose of this study was to determine the diagnostic yield of esophageal SPTs using Lugol chromoendoscopy. Methods A systematic review of all available databases was performed to find all Lugol chromoendoscopy screening studies. Results Fifteen studies with a total of 3386 patients were included. The average yield of esophageal‐SPTs in patients with HNSCC was 15%. The prevalence was the highest for patients with an index hypopharyngeal (28%) or oropharyngeal (14%) tumor. The esophageal‐SPTs were classified as high‐grade dysplasia in 49% of the cases and as invasive carcinoma's in 51%. Conclusion Our results show that 15% of the patients with HNSCC that underwent Lugol chromoendoscopy were diagnosed with an esophageal‐SPT. Based on these results there is enough evidence to perform Lugol chromoendoscopy, especially in an Asian patient population.
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Affiliation(s)
- Oisín Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Steffi E M van de Ven
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arjun D Koch
- Department of Gastroenterology and Hepatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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27
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Prueksapanich P, Luangsukrerk T, Pittayanon R, Sanpavat A, Rerknimitr R. Bimodal Chromoendoscopy with Confocal Laser Endomicroscopy for the Detection of Early Esophageal Squamous Cell Neoplasms. Clin Endosc 2018; 52:144-151. [PMID: 30300985 PMCID: PMC6453853 DOI: 10.5946/ce.2018.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/19/2018] [Indexed: 01/14/2023] Open
Abstract
Background/Aims This study aimed to evaluate the diagnostic accuracy of dual-focus narrow-band imaging (dNBI) and Lugol’schromoendoscopy (LCE) combined with probe-based confocal laser endomicroscopy (pCLE) to screen for esophageal squamous cell neoplasms (ESCNs) in patients with a history of head and neck cancer.
Methods From March to August 2016, dNBI was performed. Next, LCE was performed, followed by pCLE and biopsy. Histology has historically been the gold standard to diagnose ESCN. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of dNBI and LCE adjunct with pCLE were determined.
Results Twenty-four patients were included. Ten ESCNs were found in 8 patients (33%). Forty percent of high-graded intraepithelial neoplasias and all low-grade intraepithelial neoplasias were overlooked by dNBI. The sensitivity, specificity, PPV, NPV, and accuracy of dNBI vs. LCE combined with pCLE were 50% vs. 80%, 62% vs. 67%, 36% vs. 44%, 75% vs. 91%, and 83% vs. 70%, respectively.
Conclusions The use of dNBI to detect ESCN was suboptimal. LCE with pCLE following dNBI had additional value for detecting esophageal dysplasia not detected by dNBI. The use of pCLE to detect dNBI-missed lesions yielded a high NPV, while pCLE-guided biopsy could reduce the number of unnecessary biopsies.
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Affiliation(s)
- Piyapan Prueksapanich
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thanawat Luangsukrerk
- Division of General Internal Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rapat Pittayanon
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Anapat Sanpavat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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28
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Wang WL, Chang IW, Chen CC, Chang CY, Tseng CH, Tai CM, Lin JT, Wang HP, Lee CT. The in vivo tissue effect of endoscopic balloon-based radiofrequency ablation in treating esophageal squamous cell neoplasia. United European Gastroenterol J 2018; 6:656-661. [PMID: 30083326 DOI: 10.1177/2050640618755236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/01/2018] [Indexed: 12/11/2022] Open
Abstract
Background Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs). However, the in vivo tissue effects of RFA on the esophageal wall are uncertain. Methods We prospectively enrolled eight patients with flat-type early ESCNs who were treated with balloon-based RFA. We evaluated the in vivo tissue effect on the esophagus using endoscopic ultrasound (EUS) and the histology of retrieved coagulum. Results The mean tumor length was 6.1 cm, and six of the eight patients achieved a complete response after primary RFA. Real-time evaluation of the tissue effect showed that the mucosa and submucosal layer were more edematous and thicker after RFA than before the procedure (mean 4.89 vs. 2.04 mm, p<.001), suggesting that the thermal effect of RFA may injure the submucosa. Histological evaluation of retrieved coagulum showed a severe cauterization (burning) effect with extensive cell necrosis; however, four cases had some residual viable neoplastic cells. Even though there were viable cells in the sloughed coagulum, half of the patients still achieved complete remission after RFA. Conclusions Our findings suggest that the thermal effect of RFA may injure the submucosal layer and enable neoplastic epithelium to slough off without "burning."
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Affiliation(s)
- Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - I-Wei Chang
- Department of Pathology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chien-Chuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Yang Chang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Cheng-Hao Tseng
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chi-Ming Tai
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
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29
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Hsu WH, Kuo CH, Wu MC, Su YC, Chen CY, Wang JY, Shih HY, Lu CY, Wu DC, Yu FJ. Application of miniprobe sonography in the local staging of earlier stage upper gastrointestinal epithelial neoplasm: A four-year experience in a single center. ADVANCES IN DIGESTIVE MEDICINE 2018. [DOI: 10.1002/aid2.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Wen-Hung Hsu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chao-Hung Kuo
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Meng-Chieh Wu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Yu-Chung Su
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chiao-Yun Chen
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Jaw-Yuan Wang
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Hsiang-Yao Shih
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Chien-Yu Lu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
| | - Fang-Jung Yu
- Division of Gastroenterology, Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Taiwan
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Development of Image-enhanced Endoscopy of the Gastrointestinal Tract: A Review of History and Current Evidences. J Clin Gastroenterol 2018; 52:295-306. [PMID: 29210900 DOI: 10.1097/mcg.0000000000000960] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endoscopy imaging of the gastrointestinal (GI) tract has evolved tremendously over the last few decades. Key milestones in the development of endoscopy imaging include the use of various dyes for chromoendoscopy, the application of optical magnification in endoscopy, the introduction of high-definition image capturing and display technology and the application of altered illuminating light to achieve vascular and surface enhancement. Aims of this review paper are to summarize the development and evolution of modern endoscopy imaging and in particular, imaged-enhanced endoscopy (IEE), to promote appropriate usage, and to guide future development of good endoscopy practice. A search of PubMed database was performed to identify articles related to IEE of the GI tract. Where appropriate, landmark trials and high-quality meta-analyses and systematic reviews were used in the discussion. In this review, the developments and evolutions in endoscopy imaging and in particular, IEE, were summarized into discernible eras and the literature evidence with regard to the strengths and weaknesses in term of their detection and characterization capability in each of these eras were discussed. It is in the authors' opinion that IEE is capable of fairly good detection and accurate characterization of various GI lesions but such benefits may not be readily reaped by those who are new in the field of luminal endoscopy. Exposure and training in making confident diagnoses using these endoscopy imaging technologies are required in tandem with these new developments in order to fully embrace and adopt the benefits.
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Hsu J, Donnelly JP, Moore JX, Meneses K, Williams G, Wang HE. National characteristics of Emergency Department visits by patients with cancer in the United States. Am J Emerg Med 2018; 36:2038-2043. [PMID: 29573899 DOI: 10.1016/j.ajem.2018.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 01/16/2023] Open
Abstract
PURPOSE The Emergency Department (ED) is an important venue for the care of patients with cancer. We sought to describe the national characteristics of ED visits by patients with cancer in the United States. METHODS We performed an analysis of 2012-2014 ED visit data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We included adult (age≥18years) ED patients, stratified by history of cancer. Using the NHAMCS survey design and weighting variables, we estimated the annual number of adult ED visits by patients with cancer. We compared demographics, clinical characteristics, ED resource utilization, and disposition of cancer vs. non-cancer patients. RESULTS There were an estimated 104,836,398 annual ED visits. Patients with cancer accounted for an estimated 3,879,665 (95% CI: 3,416,435-4,342,895) annual ED visits. Compared with other ED patients, those with cancer were older (mean 64.8 vs. 45.4years), more likely to arrive by Emergency Medical Services (28.0 vs. 16.9%), and experienced longer lengths of ED stay (mean 4.9 vs. 3.8h). Over 65% of ED patients with cancer underwent radiologic imaging. Patients with cancer almost twice as likely to undergo CT scanning; four times more likely to present with sepsis; twice as likely to present with thrombosis, and three times more likely to be admitted to the hospital than non-cancer patients. CONCLUSIONS Patients with cancer comprise nearly 4 million ED visits annually. The findings highlight the important role of the ED in cancer care and need for addressing acute care conditions in patients with cancer.
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Affiliation(s)
- Joann Hsu
- University of Alabama School of Medicine, Birmingham, AL, United States
| | - John P Donnelly
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Justin Xavier Moore
- University of Alabama School of Medicine, Birmingham, AL, United States; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, United States; Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Karen Meneses
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States; School of Nursing, University of Alabama at Birmingham Birmingham, AL
| | - Grant Williams
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Henry E Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, United States; Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States.
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Safatle-Ribeiro AV, Baba ER, Faraj SF, Rios JT, de Lima MS, Martins BC, Geiger SN, Pennacchi C, Gusman C, Kawaguti FS, Uemura RS, de Melo ES, Ribeiro U, Maluf-Filho F. Diagnostic accuracy of probe-based confocal laser endomicroscopy in Lugol-unstained esophageal superficial lesions of patients with head and neck cancer. Gastrointest Endosc 2017; 85:1195-1207. [PMID: 27697445 DOI: 10.1016/j.gie.2016.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 09/18/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Surveillance programs of patients with head and neck cancer (HNC) detect synchronous or metachronous esophageal squamous cell carcinoma (ESCC) in up to 15% of patients. Noninvasive, probe-based confocal laser endomicroscopy (pCLE) technique may improve the diagnosis allowing acquisition of high-resolution in vivo images at the cellular and microvascular levels. The aim of this study was to evaluate the accuracy of pCLE for the differential diagnosis of nonneoplastic and neoplastic Lugol-unstained esophageal lesions in patients with HNC. METHODS Twenty-seven patients with HNC who exhibited Lugol-unstained esophageal lesions at surveillance endoscopy were prospectively included for pCLE. Diagnostic pCLE was followed by subsequent biopsies or endoscopic resection of suspected lesions. A senior pathologist was blinded to the pCLE results. RESULTS Patients mean age was 59 years (SD = 8.8) and 70.4% were men. All patients were smokers, and 22 patients (81.5%) had a history of alcohol consumption. The locations of HNC were oral cavity (n = 13), larynx (n = 10), and pharynx (n = 4). Thirty-seven lesions in 27 patients were studied. The final diagnoses were ESCC in 17 patients and benign lesions in 20 patients. Sensitivity, specificity, and accuracy of pCLE for the histologic diagnosis of ESCC in patients with HNC were 94.1%, 90.0%, and 91.9%, respectively. CONCLUSIONS First, pCLE is highly accurate for real-time histology of Lugol-unstained esophageal lesions in patients with HNC. Second, pCLE may alter the management of patients under surveillance for ESCC, guiding biopsies and endoscopic resection, avoiding further diagnostic workup or therapy of benign lesions.
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Affiliation(s)
- Adriana Vaz Safatle-Ribeiro
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Elisa Ryoka Baba
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Sheila Friedrich Faraj
- Department of Pathology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Juliana Trazzi Rios
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Marcelo Simas de Lima
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Bruno Costa Martins
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Sebastian Naschold Geiger
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Caterina Pennacchi
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Carla Gusman
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Fábio Shiguehissa Kawaguti
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Ricardo Sato Uemura
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Evandro Sobroza de Melo
- Department of Pathology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Ulysses Ribeiro
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
| | - Fauze Maluf-Filho
- Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil
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Wang WL, Chang IW, Chen CC, Chang CY, Mo LR, Lin JT, Wang HP, Lee CT. A case series on the use of circumferential radiofrequency ablation for early esophageal squamous neoplasias in patients with esophageal varices. Gastrointest Endosc 2017; 85:322-329. [PMID: 27365263 DOI: 10.1016/j.gie.2016.06.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/17/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early esophageal squamous cell neoplasias (ESCNs). However, the feasibility of RFA for ESCNs in the setting of esophageal varices has not been reported. METHODS We retrospectively enrolled 8 consecutive patients with cirrhosis (Child-Pugh score ≤6) with early flat-type ESCNs (high-grade intraepithelial neoplasia/intramucosal cancer, and Lugol unstained lesion [USL] length ≥3 cm extending ≥1/2 the circumference) on or adjacent to esophageal varices, for which circumferential RFA was applied as the initial treatment. The primary endpoint was a complete response at 12 months, and the secondary endpoints were adverse events and procedure-related mortality. RESULTS The mean USL length was 5.3 cm (range, 3-10 cm), and the average length of the treatment area was 7.5 cm (range, 5-12 cm), with an average procedure time of 31.9 min (range, 25-40 min). After circumferential RFA, 3 adverse events were recorded, including 2 intramucosal hematomas and 1 mucosal laceration, all of which spontaneously resolved without further management. No massive bleeding, perforation, stricture, or hepatic failure occurred after the procedure. Six of the 8 patients achieved a complete response after single circumferential RFA, but 2 had residual squamous neoplasias. After additional focal-type RFA treatment, all achieved a complete response at 12 months. No neoplastic progression or recurrence occurred during a median follow-up period of 21.6 months (range, 13-42 months). CONCLUSIONS RFA was associated with good treatment results, no neoplastic progression, and an acceptable adverse event profile for the treatment of early ESCNs in patients with well-compensated cirrhosis and esophageal varices.
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Affiliation(s)
- Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - I-Wei Chang
- Department of Pathology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chien-Chuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Yang Chang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Lein-Ray Mo
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine and Big Data Research Centre, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
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Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis. BMC Cancer 2017; 17:54. [PMID: 28086818 PMCID: PMC5237308 DOI: 10.1186/s12885-016-3011-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/15/2016] [Indexed: 12/15/2022] Open
Abstract
Background In the early stage esophageal cancer, changes in the mucosa are subtle and pass unnoticed in endoscopic examinations using white light. To increase sensitivity, chromoscopy with Lugol’s solution has been used. Technological advancements have led to the emergence of virtual methods of endoscopic chromoscopy, including narrow band imaging (NBI). NBI enhances the relief of the mucosa and the underlying vascular pattern, providing greater convenience without the risks inherent to the use of vital dye. The purpose of this systematic review and meta-analysis was to evaluate the ability of NBI to diagnose squamous cell carcinoma of the esophagus and to compare it to chromoscopy with Lugol’s solution. Methods This systematic review included all studies comparing the diagnostic accuracy of NBI and Lugol chromoendoscopy performed to identify high-grade dysplasia and/or squamous cell carcinoma in the esophagus. In the meta-analysis, we calculated and demonstrated sensitivity, specificity, and positive and negative likelihood values in forest plots. We also determined summary receiver operating characteristic (sROC) curves and estimates of the areas under the curves for both per-patient and per-lesion analysis. Results The initial search identified 7079 articles. Of these, 18 studies were included in the systematic review and 12 were used in the meta-analysis, for a total of 1911 patients. In per-patient and per-lesion analysis, the sensitivity, specificity, and positive and negative likelihood values for Lugol chromoendoscopy were 92% and 98, 82 and 37%, 5.42 and 1.4, and 0.13 and 0.39, respectively, and for NBI were 88 and 94%, 88 and 65%, 8.32 and 2.62, and 0.16 and 0.12, respectively. There was a statistically significant difference in only specificity values, in which case NBI was superior to Lugol chromoendoscopy in both analyses. In the per-patient analysis, the area under the sROC curve for Lugol chromoendoscopy was 0.9559. In the case of NBI, this value was 0.9611; in the per-lesion analysis, this number was 0.9685 and 0.9587, respectively. Conclusions NBI was adequate in evaluating the esophagus in order to diagnose high-grade dysplasia and squamous cell carcinoma. In the differentiation of those disorders from other esophageal mucosa alterations, the NBI was shown to be superior than Lugol.
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Chaber-Ciopinska A, Kiprian D, Kawecki A, Kaminski MF. Surveillance of patients at high-risk of squamous cell esophageal cancer. Best Pract Res Clin Gastroenterol 2016; 30:893-900. [PMID: 27938784 DOI: 10.1016/j.bpg.2016.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 01/31/2023]
Abstract
Currently curative treatment for esophageal squamous cell cancer (ESCC) is possible only in patients with early-stage, usually asymptomatic disease. In Western countries, where the incidence of ESCC is relatively low, a screening of asymptomatic, average-risk population is untenable. In order to detect early-stage ESCC or its precursor lesions it is important to identify high-risk patients and consider endoscopic surveillance in these groups. These high-risk groups include patients after curative treatment for head and neck cancer, previous endoscopic resection of ESCC, caustic injury, and patients with tylosis or achalasia. This paper discuss the evidence and proposed method of endoscopy surveillance of these high-risk patients.
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Affiliation(s)
- A Chaber-Ciopinska
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland
| | - D Kiprian
- Department of Head and Neck Cancer, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - A Kawecki
- Department of Head and Neck Cancer, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - M F Kaminski
- Department of Gastroenterological Oncology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland; Department of Gastroenterology, Hepatology and Oncology, Medical Center for Postgraduate Education, Warsaw, Poland; Institute of Health and Society, University of Oslo, Oslo, Norway.
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Chou CK, Lee YC. Transnasal endoscopic gastrostomy for patients whose condition limits standard oral endoscopic intubation. ADVANCES IN DIGESTIVE MEDICINE 2016. [DOI: 10.1016/j.aidm.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang WL, Chang IW, Chen CC, Chang WL, Chu YY, Wu PH, Tai WC, Chen PY, Hsieh PH, Chung CS, Chang CY, Lin JT, Wang HP, Lee CT. Predictors for postoperative esophageal stricture after balloon-based radiofrequency ablation for early esophageal squamous neoplasia: a multicenter validation study. Therap Adv Gastroenterol 2016; 9:257-64. [PMID: 27134656 PMCID: PMC4830103 DOI: 10.1177/1756283x16633051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic radiofrequency ablation (RFA) is a rapidly evolving therapeutic modality for early flat esophageal squamous cell neoplasms (ESCNs), but the risk factors for postoperative stricture have not been elucidated. The objective of this study was to identify and validate a predictor for post-RFA stenosis. METHODS We consecutively enrolled patients with flat-type 'large' (length no less than 3 cm extending no less than half the circumference of the esophagus), early ESCNs, treated with balloon-based RFA (12 J/cm(2)-clean-12 J/cm(2) regimen). The tumor and technical factors for postoperative stricture were investigated and we validated the results externally with a society-based multicenter cohort using the same ablation regimen. RESULTS A total of 51 patients were enrolled (30 in the development set and 21 in the validation set). The complete remission rate at 12 months was 93%, and the rates of perforation and postoperative stenosis were 0% and 17%, respectively. Patients with post-RFA stenosis had a significantly larger longitudinal tumor size (mean 115 versus 61 mm, p = 0.003). There were no significant differences in age, body mass index, tumor circumferential extension, pretreatment histological grade, treatment efficacy or size of balloon catheter between the groups with or without stenosis. The optimal cut-off value was set as 9 cm to predict post-RFA stenosis by receiver operating characteristic curve [area under curve (AUC) = 0.881], which was then confirmed to be a reliable predictor by multivariate analysis (odds ratio, 12.7, 95% confidence interval, 1.18-136.28, p = 0.03) and have a good predictive performance in the validation set (AUC = 0.876). CONCLUSIONS The most frequent adverse event of RFA was esophageal stenosis, for which the longitudinal tumor size was a significant predictive factor. Early intervention or prevention for stricture should be applied for those with long segment (⩾9 cm) ESCNs.
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Affiliation(s)
- Wen-Lun Wang
- Department of Internal Medicine, Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - I-Wei Chang
- Department of Pathology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Chien-Chuan Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Lun Chang
- Department of Internal Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan
| | - Yin-Yi Chu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ping-Hsiu Wu
- Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wei-Chen Tai
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Yueh Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Ping-Hsin Hsieh
- Department of Gastroenterology, Chimei Medical Center, Tainan, Taiwan
| | - Chen-Shuan Chung
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Yang Chang
- Department of Internal Medicine, Da Hospital/I-Shou University, Kaohsiung, Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, Da Hospital/I-Shou University, Kaohsiung, Taiwan,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University, No. 1, Changde St., Zhongzheng Dist., Taipei City 10048, Taiwan
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Huang YC, Lee YC, Tseng PH, Chen TC, Yang TL, Lou PJ, Ko JY, Liao LJ, Hsu WL, Chang YL, Wang CP. Regular screening of esophageal cancer for 248 newly diagnosed hypopharyngeal squamous cell carcinoma by unsedated transnasal esophagogastroduodenoscopy. Oral Oncol 2016; 55:55-60. [DOI: 10.1016/j.oraloncology.2016.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 02/07/2023]
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Knabe M, May A, Ell C. Endoscopic Therapy of Early Carcinoma of the Oesophagus. VISZERALMEDIZIN 2016; 31:320-5. [PMID: 26989386 PMCID: PMC4789909 DOI: 10.1159/000441075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Oesophageal cancer is a comparatively rare disease in the Western world. Prognosis is highly dependent on the choice of treatment. Early stages can be treated by endoscopic resection, whereas surgery needs to be performed in the case of advanced carcinomas. Technical progress has enabled high-definition endoscopes and technical add-ons which help the endoscopist in finding fine irregularities in the oesophageal mucosa, though interpretation still remains challenging. Methods In this review, we discuss both novel and old diagnostic procedures and their value, as well as the current recommendations for the diagnosis and treatment of early oesophageal carcinomas. The database of PubMed and Medline was searched and analysed to provide all relevant literature for this review. Results and Conclusion Endoscopic resection is the therapy of choice in early oesophageal cancer. In case of adenocarcinoma it is mandatory to perform subsequent ablation of all residual Barrett's mucosa to avoid metachronous lesions.
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Affiliation(s)
- Mate Knabe
- Department of Medicine II/IV, Sana Klinikum Offenbach, Offenbach, Germany
| | - Andrea May
- Department of Medicine II/IV, Sana Klinikum Offenbach, Offenbach, Germany
| | - Christian Ell
- Department of Medicine II/IV, Sana Klinikum Offenbach, Offenbach, Germany
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Cosway B, Drinnan M, Paleri V. Narrow band imaging for the diagnosis of head and neck squamous cell carcinoma: A systematic review. Head Neck 2016; 38 Suppl 1:E2358-67. [DOI: 10.1002/hed.24300] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/19/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Benjamin Cosway
- Department of Otolaryngology - Head and Neck Surgery; Freeman Hospital; Newcastle United Kingdom
| | - Michael Drinnan
- Department of Clinical Engineering; Freeman Hospital; Newcastle United Kingdom
| | - Vinidh Paleri
- Department of Otolaryngology - Head and Neck Surgery; Freeman Hospital; Newcastle United Kingdom
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Diagnostic value of probe-based confocal laser endomicroscopy and high-definition virtual chromoendoscopy in early esophageal squamous neoplasia. Gastrointest Endosc 2016; 81:1346-54. [PMID: 25680899 DOI: 10.1016/j.gie.2014.10.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Detection and differentiation of esophageal squamous neoplasia (ESN) are of value in improving patient outcomes. Probe-based confocal laser endomicroscopy (pCLE) can serve in targeted biopsies in the diagnosis of GI neoplasia. However, its performance in ESN has not yet been reported. OBJECTIVE To investigate the diagnostic value of pCLE for early ESN screened by high-definition virtual chromoendoscopy (I-Scan) and verified by Lugol chromoendoscopy and histopathology. DESIGN Prospective and noninferiority trial. SETTING Single center in China. PATIENTS Patients were enrolled who (1) previously had histologically verified early ESN or (2) were about to undergo screening endoscopy and were 50 to 80 years of age between February 2013 and February 2014. INTERVENTIONS The esophagus was investigated sequentially by white-light endoscopy, I-Scan, then pCLE and iodine chromoendoscopy. The results were interpreted and compared with histopathologic results. MAIN OUTCOME MEASUREMENTS Diagnostic characteristics of pCLE and I-Scan. RESULTS In total, 356 patients were enrolled. In all, 42 patients were histologically proven to have 47 neoplasias. The diagnostic value of pCLE for ESN during ongoing endoscopy has a sensitivity, specificity, and accuracy of 94.6%, 90.7%, and 92.3%, respectively. The interobserver and intraobserver agreement was good and excellent, with κ values of 0.699 and 0.895, respectively. The detection rate by using I-Scan and Lugol chromoendoscopy was 10.4% and 12.9%, respectively (P<.01 for noninferiority). LIMITATIONS Single center. CONCLUSIONS pCLE shows promise in diagnosing and differentiating ESN in vivo. The screening performance of I-Scan in the detection of ESN is noninferior to that of iodine chromoendoscopy.
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Chen L, Huang XJ, Sun Y. Endoscopic diagnosis of early esophageal carcinoma. Shijie Huaren Xiaohua Zazhi 2016; 24:51-58. [DOI: 10.11569/wcjd.v24.i1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Esophageal carcinoma is one of the common malignant tumors in the world and China has the highest incidence and mortality rates. With the development of endoscopic techniques, the diagnosis rate of early esophageal carcinoma is greatly improved in recent years, and endoscopic techniques have been accepted as the first choice for diagnosis of early esophageal carcinoma. This paper reviews endoscopic diagnosis methods, including chromoendoscopy, narrow-band imaging, endoscopic ultrasonography, magnification endoscopy, fluorescence endoscopy, confocal laser endomicroscopy, Fujinon intelligent chromoendoscopy, I-Scan, endocytoscopy, optical coherence tomography, three-dimensional endoscopic imaging, endoscopic capsule endoscopy, and elastic scattering spectroscopy.
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Wang WL, Chang IW, Chen CC, Chang CY, Mo LR, Lin JT, Wang HP, Lee CT. Radiofrequency Ablation Versus Endoscopic Submucosal Dissection in Treating Large Early Esophageal Squamous Cell Neoplasia. Medicine (Baltimore) 2015; 94:e2240. [PMID: 26656367 PMCID: PMC5008512 DOI: 10.1097/md.0000000000002240] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Radiofrequency ablation (RFA) and endoscopic submucosal dissection (ESD) can potentially be applied for early esophageal squamous cell neoplasia (ESCN); however, no study has directly compared these 2 modalities.We retrospectively enrolled the patients with flat-type "large" (length ≥3 cm extending ≥1/2 of the circumference of esophagus) early ESCNs treated endoscopically. The main outcome measurements were complete response at 12 months, and adverse events.Of a total of 65 patients, 18 were treated with RFA and 47 with ESD. The procedure time of RFA was significantly shorter than that of ESD (126.6 vs 34.8 min; P < 0.001). The complete resection rate of ESD and complete response rate after primary RFA were 89.3% and 77.8%, respectively. Based on the histological evaluation of the post-ESD specimens showed 14 of 47 (29.8%) had histological upstaging compared with the pre-ESD biopsies, and 4 of them had lymphovascular invasion requiring chemoradiation or surgery. After additional therapy for residual lesions, 46 (97.9%) patients in the ESD group and 17 (94.4%) patients in the RFA group achieved a complete response at 12 months. Four patients (8.5%) developed major procedure-related adverse events in the ESD group, but none in the RFA group. In patients with lesions occupying more than 3/4 of the circumference, a significantly higher risk of esophageal stenosis was noted in the ESD group compared with RFA group (83% vs 27%, P = 0.01), which required more sessions of dilatation to resolve the symptoms (median, 13 vs 3, P = 0.04). There were no procedure-related mortality or neoplastic progression in either group; however, 1 patient who received ESD and 1 who received RFA developed local recurrence during a median follow-up period of 32.4 (range, 13-68) and 18.0 (range, 13-41) months, respectively.RFA and ESD are equally effective in the short-term treatment of early flat large ESCNs; however, more adverse events occur with ESD, especially in lesions extending more than 3/4 of the circumference. RFA does not allow for pathology to evaluate the curability after ablation, and thus currently the use for invasive ESCNs should be conservative until longer follow-up studies are available.
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Affiliation(s)
- Wen-Lun Wang
- From the Department of Internal Medicine (W-LW, C-YC, L-RM, J-TL, C-TL) and Department of Pathology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan (I-WC); Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan (C-CC, J-TL, H-PW); and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan (J-TL)
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Wang WL, Wang YC, Chang CY, Lo JL, Kuo YH, Hwang TZ, Wang CC, Mo LR, Lin JT, Lee CT. Human papillomavirus infection on initiating synchronous esophageal neoplasia in patients with head and neck cancer. Laryngoscope 2015; 126:1097-102. [PMID: 27107411 DOI: 10.1002/lary.25728] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 09/02/2015] [Accepted: 09/15/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV) is a risk factor for head and neck squamous cell carcinoma (HNSCC) as well as esophageal squamous cell carcinoma (ESCC). We aimed to investigate whether HPV infection underlies the field cancerization phenomenon over upper aerodigestive tract to develop synchronous multiple cancers. STUDY DESIGN A case control study. METHODS The presence and subtype of HPV-DNA sequence in cancers were examined by polymerase chain reaction and sequencing in a prospective cohort with 100 HNSCCs, 50 of which had synchronous ESCCs. The clinicopathologic characteristics were further analyzed according to the presence of HPV. RESULTS Twelve patients were HPV-positive, of which 11 were positive for HPV-16. The prevalence of HPV infection were not different between the synchronous and HNSCC alone groups (P = 0.357). Testing for HPV in paired HNSCC and ESCC tissues from the same patient revealed that none were concomitantly HPV-positive. Multivariate logistic regression showed drinking alcohol (odds ratio [OR], 18.75; P = 0.030), alcohol flushing (OR, 2.53; P = 0.041), and body mass index (OR, 0.77; P = 0.001) but not HPV infection were independent risk factors for synchronous phenotype. The patients with synchronous ESCCs had significantly poorer survival than those with HNSCC alone (5-year overall survival: 30% vs. 70%; log-rank P < 0.001). However, patients with HPV-positive HNSCC tend to have favorable outcome than those with HPV-negative HNSCC. CONCLUSIONS HPV infection plays little role in field cancerization phenomenon to initiate synchronous SCC. The synchronous HNSCC and ESCC from the same patients had no clonal relationship. Routine endoscopic examination of the esophagus should be recommended for patients with risk factors identified. LEVELS OF EVIDENCE NA. Laryngoscope, 126:1097-1102, 2016.
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Affiliation(s)
- Wen-Lun Wang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung
| | - Yu-Chi Wang
- Department of Biological Science and Technology, E-Da Hospital/I-Shou University, Kaohsiung
| | - Chi-Yang Chang
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung
| | - Jo-Lin Lo
- Department of Oncology, E-Da Hospital/I-Shou University, Kaohsiung
| | - Yao-Hung Kuo
- Department of Radiation Oncology, E-Da Hospital/I-Shou University, Kaohsiung
| | - Tzer-Zen Hwang
- Department of Otolaryngology, E-Da Hospital/I-Shou University, Kaohsiung
| | - Chih-Chun Wang
- Department of Otolaryngology, E-Da Hospital/I-Shou University, Kaohsiung
| | - Lein-Ray Mo
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung
| | - Jaw-Town Lin
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ching-Tai Lee
- Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung
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Chung CS, Lo WC, Lee YC, Wu MS, Wang HP, Liao LJ. Image-enhanced endoscopy for detection of second primary neoplasm in patients with esophageal and head and neck cancer: A systematic review and meta-analysis. Head Neck 2015; 38 Suppl 1:E2343-9. [DOI: 10.1002/hed.24277] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/13/2015] [Accepted: 09/12/2015] [Indexed: 12/16/2022] Open
Affiliation(s)
- Chen-Shuan Chung
- Department of Internal Medicine; Far Eastern Memorial Hospital; Banciao District New Taipei City Taiwan
- College of Medicine; Fu Jen Catholic University; New Taipei City Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology; Far Eastern Memorial Hospital; Banciao District New Taipei City Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ming-Shiang Wu
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Hsiu-Po Wang
- Department of Internal Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology; Far Eastern Memorial Hospital; Banciao District New Taipei City Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health; National Taiwan University; Taipei Taiwan
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Su JW, Lin YH, Chiang CP, Lee JM, Hsieh CM, Hsieh MS, Yang PW, Wang CP, Tseng PH, Lee YC, Sung KB. Precancerous esophageal epithelia are associated with significantly increased scattering coefficients. BIOMEDICAL OPTICS EXPRESS 2015; 6:3795-805. [PMID: 26504630 PMCID: PMC4605039 DOI: 10.1364/boe.6.003795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 05/04/2023]
Abstract
The progression of epithelial precancers into cancer is accompanied by changes of tissue and cellular structures in the epithelium. Correlations between the structural changes and scattering coefficients of esophageal epithelia were investigated using quantitative phase images and the scattering-phase theorem. An ex vivo study of 14 patients demonstrated that the average scattering coefficient of precancerous epithelia was 37.8% higher than that of normal epithelia from the same patient. The scattering coefficients were highly correlated with morphological features including the cell density and the nuclear-to-cytoplasmic ratio. A high interpatient variability in scattering coefficients was observed and suggests identifying precancerous lesions based on the relative change in scattering coefficients.
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Affiliation(s)
- Jing-Wei Su
- Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan
| | - Yang-Hsien Lin
- Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan
| | - Chun-Ping Chiang
- Department of Dentistry, National Taiwan University Hospital, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Jang-Ming Lee
- Department of Surgery, National Taiwan University Hospital, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Chao-Mao Hsieh
- Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan
| | - Min-Shu Hsieh
- Department of Pathology, National Taiwan University Hospital, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Pei-Wen Yang
- Department of Surgery, National Taiwan University Hospital, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Chen-Ping Wang
- Department of Otolaryngology, National Taiwan University Hospital, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Ping-Huei Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, Taiwan
- National Taiwan University College of Medicine, Taiwan
| | - Kung-Bin Sung
- Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taiwan
- Department of Electrical Engineering, National Taiwan University, Taiwan
- Molecular Imaging Center, National Taiwan University, Taiwan
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Value of probe-based confocal laser endomicroscopy (pCLE) and dual focus narrow-band imaging (dNBI) in diagnosing early squamous cell neoplasms in esophageal Lugol's voiding lesions. Endosc Int Open 2015; 3:E281-8. [PMID: 26356321 PMCID: PMC4554495 DOI: 10.1055/s-0034-1391903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/20/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Lugol's chromoendoscopy provides excellent sensitivity for the detection of early esophageal squamous cell neoplasms (ESCN), but its specificity is suboptimal. An endoscopy technique for real-time histology is required to decrease the number of unnecessary biopsies. This study aimed to compare the ESCN diagnostic capability of probed-based confocal laser endomicroscopy (pCLE) and dual focus narrow-band imaging (dNBI) in Lugol's voiding lesions. PATIENTS AND METHODS Patients with a history of head and neck cancer without dysphagia were recruited. Lugol's voiding lesions larger than 5 mm were sequentially characterized by dNBI and pCLE by two independent operators. Finally, all lesions larger than 5 mm were biopsied followed by histological analysis, which is considered to be the gold standard in cancer diagnosis. The primary outcomes were the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the accuracy of the two techniques. RESULTS In total, 44 patients were enrolled with a mean age of 60 years; 80 % were male. Twenty-one Lugol's voiding lesions larger than 5 mm were detected in 12 patients. Seven lesions (33 %) from four patients were histologically diagnosed as ESCNs (four with high grade dysplasia and three with low grade dysplasia). The other 14 lesions were histologically confirmed as non-neoplastic: active esophagitis, glycogenation with inflammation, acute ulcer, inlet patch, and unremarkable changes. The sensitivity, specificity, PPV, NPV, and accuracy of pCLE vs. dNBI were 83 % vs. 85 %, 92 % vs. 62 %, 83 % vs. 54 %, 92 % vs. 89 %, and 89 % vs. 70 %, respectively (NS). CONCLUSIONS Asymptomatic patients with a history of head and neck cancer underwent Lugol's chromoendoscopy based ESCN surveillance. Further characterization of the Lugol's voiding lesions by advanced imaging showed that both pCLE and dNBI provided good sensitivity in diagnosing ESCN, and pCLE tended to provide higher specificity, PPV, and accuracy than dNBI. Perhaps the trend of lower specificity of dNBI in this study was possibly because of the interference from Lugol's stain on the interpretation of intrapapillary capillary loops (IPCLs). Further study is required to seek a significant difference in the performance of dNBI and pCLE in a larger group of patients.
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Yamasaki Y, Takenaka R, Hori K, Takemoto K, Kawano S, Kawahara Y, Okada H, Fujiki S, Yamamoto K. Tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening. World J Gastroenterol 2015; 21:2793-2799. [PMID: 25759551 PMCID: PMC4351233 DOI: 10.3748/wjg.v21.i9.2793] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/21/2014] [Accepted: 12/22/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening with that of lugol chromoendoscopy.
METHODS: We prospectively enrolled and analyzed 51 patients who were at high risk for esophageal cancer. All patients were divided into two groups: a magnifying narrow band imaging group, and a lugol chromoendoscopy group, for comparison of adverse symptoms. Esophageal cancer screening was performed on withdrawal of the endoscope. The primary endpoint was a score on a visual analogue scale for heartburn after the examination. The secondary endpoints were scale scores for retrosternal pain and dyspnea after the examinations, change in vital signs, total procedure time, and esophageal observation time.
RESULTS: The scores for heartburn and retrosternal pain in the magnifying narrow band imaging group were significantly better than those in the lugol chromoendoscopy group (P = 0.004, 0.024, respectively, ANOVA for repeated measures). The increase in heart rate after the procedure was significantly greater in the lugol chromoendoscopy group. There was no significant difference between the two groups with respect to other vital sign. The total procedure time and esophageal observation time in the magnifying narrow band imaging group were significantly shorter than those in the lugol chromoendoscopy group (450 ± 116 vs 565 ± 174, P = 0.004, 44 ± 26 vs 151 ± 72, P < 0.001, respectively).
CONCLUSION: Magnifying narrow band imaging endoscopy reduced the adverse symptoms compared with lugol chromoendoscopy. Narrow band imaging endoscopy is useful and suitable for esophageal cancer screening periodically.
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Chung CS, Lee YC, Liou JM, Wang CP, Ko JY, Lee JM, Wu MS, Wang HP. Tag single nucleotide polymorphisms of alcohol-metabolizing enzymes modify the risk of upper aerodigestive tract cancers: HapMap database analysis. Dis Esophagus 2014; 27:493-503. [PMID: 23088731 DOI: 10.1111/j.1442-2050.2012.01437.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although alcohol is associated with higher upper aerodigestive tract (UADT) cancer risk, only a small fraction of alcoholics develop cancers. There is a lack of evidence proving the association of tag single nucleotide polymorphisms of alcohol-metabolizing enzymes with cancer risk. The aim of this study was to determine the association of these genetic polymorphisms with UADT cancer risk in a Chinese population. It was a hospital-based case-control candidate gene study. The databases of the International HapMap Project were searched for haplotype tag single nucleotide polymorphisms of the genes alcohol dehydrogenase (ADH)1B, ADH1C, and aldehyde dehydrogenase (ALDH)2. The genotyping was performed by the Sequenom MassARRAY system. Totally, 120 head and neck squamous cell carcinoma, 138 esophageal squamous cell carcinoma patients, and 276 age- and gender-matched subjects were enrolled between June 2008 and June 2010.Minor alleles of ADH1B (rs1229984) and ALDH2(rs671) were not only associated with the risk of UADT cancers (odds ratio [OR] [95% confidence interval, CI]: 3.53 [2.14-5.80] and 2.59 [1.79-3.75], respectively) but also potentiated the carcinogenic effects of alcohol (OR [95% CI]: 53.44 [25.21-113.29] and 70.08 [33.65-145.95], respectively). Similar effects were observed for head/neck and esophageal cancer subgroups. Multivariate logistic regression analysis identified four significant risk factors, including habitual use of cigarettes, alcohol, betel quid, and lower body mass index (P < 0.001). The haplotypes GAGC (OR 1.61, 95% CI 1.08-2.40, P = 0.018) and CCAATG (OR 1.69, 95% CI 1.24-2.30, P < 0.001) on chromosomes 4 and 12, respectively, were associated with higher cancer risk. These findings suggested that risk allele or haplotype carriers who consume alcohol and other carcinogens should be advised to undergo endoscopy screening. The information can be used to determine the degree of susceptibility of each subject and can be combined with other environmental factors, like carcinogen consumption, in the screening analysis.
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Affiliation(s)
- C-S Chung
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Usefulness of non-magnifying narrow-band imaging in screening of early esophageal squamous cell carcinoma: a prospective comparative study using propensity score matching. Am J Gastroenterol 2014; 109:845-54. [PMID: 24751580 PMCID: PMC4050526 DOI: 10.1038/ajg.2014.94] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 03/12/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The usefulness of non-magnifying endoscopy with narrow-band imaging (NBI; NM-NBI) in the screening of early esophageal squamous cell carcinoma (SCC) and high-grade intraepithelial neoplasia (HGIN) remains unclear. Here, we aimed to compare NM-NBI and chromoendoscopy with iodine staining (CE-Iodine) in terms of the diagnostic performance, and to evaluate the usefulness of NM-NBI in detecting early esophageal SCC. METHODS We prospectively enrolled 202 consecutive patients (male/female=180/22; median age, 67 years) with high-risk factors for esophageal SCC. All patients received endoscopic examination with NM-NBI and CE-Iodine to screen for early esophageal SCC or HGIN. We conducted the examinations sequentially, and calculated the accuracy, sensitivity, and specificity through a per-lesion-based analysis. A propensity score matching analysis was performed to reduce the effects of selection bias, and we compared the respective outcomes according to NM-NBI and CE-Iodine after matching. RESULTS The accuracy, sensitivity, and specificity of NM-NBI were 77.0, 88.3, and 75.2%, respectively, and those for unstained areas by CE-Iodine were 68.0, 94.2, and 64.0, respectively. The accuracy and specificity of NM-NBI were superior to those of CE-Iodine (P=0.03 and P=0.01, respectively). However, the sensitivity did not significantly differ between NM-NBI and CE-Iodine (P=0.67). The accuracy and specificity of NM-NBI before matching were superior to those of CE-Iodine after matching (P=0.04 and P=0.03). CONCLUSIONS NM-NBI was useful and reliable for the diagnosis of esophageal SCC and can be a promising screening strategy for early esophageal SCC.
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