Transnasal endoscopy with narrow-band imaging and Lugol staining to screen patients with head and neck cancer whose condition limits oral intubation with standard endoscope (with video)

摘要

Background: Eariy detection of esophageal cancer in patients with head and neck cancers may alter treatment planning and improve survival. However, standard endoscopic screening is not feasible for some patients with tumor-related airway compromise or postirradiation trismus.Objective: To evaluate a novel, sequential approach by integrating ultrathin endoscopy with narrow-band imaging and Lugol chromoendoscopy.Design: Cross-sectional study. Setting: Single center in Taiwan.Patients: Forty-four consecutive patients with transoral difficulty screened for synchronous or metachronous esophageal cancer.Main Outcome Measurements: Sensitivity, specificity, and accuracy in the detection of mucosal high-grade neoplasia or invasive cancer.Results: Fifty-four endoscopic interpretations were obtained, and 11 mucosal high-grade neoplasia and 7 invasive cancers were confirmed by histology. The mean examination time was 19-4 minutes (range 7.9-35-2 minutes), and all patients tolerated the procedure well. Sensitivity, specificity, and accuracy (with 95% CI) were 55-6% (95% CI, 33.5%-75.6%), 97.2% (95% CI, 85-8%-99.3%), and 83.3% (95% CI, 71.2%-90.9%), respectively for standard endoscopy; 88.9% (95% CI, 66.9%-96.6%), 97.2% (95% CI, 85.8%-99.3%), and 94.4% (95% CI, 84.9%-97.9%), respectively with the adjunct of narrow-band imaging; and 88.9% (95% CI, 66.9%-9