Chromoendoscopy to Detect Early Synchronous Second Primary Esophageal Carcinoma in Patients with Squamous Cell Carcinomas of the Head and Neck?

Pavel Komínek,Ondřej Urban,Karol Zeleník,Jakub Cvek,Petr Matoušek,Petr Vítek,Magdaléna Halamka,David Feltl

doi:10.1155/2013/236264

Abstract

Objective. To evaluate the use of flexible esophagoscopy and chromoendoscopy with Lugol's solution in the detection of early esophageal carcinomas (second primary carcinomas) in patients with squamous cell carcinoma of the head and neck (HNSCC). Methods. All patients with newly diagnosed HNSCC underwent office-based Lugol's chromoendoscopy. After flexible esophagoscopy with white light, 3.0% Lugol's iodine solution was sprayed over the entire esophageal mucosa. Areas with less-intense staining (LVLs) were evaluated and biopsies taken. Results. 132 patients with HNSCC were enrolled in this study. The most frequent primary tumors were oropharyngeal (49/132), tumors of the oral cavity (36/132), and larynx (35/132). The majority of subjects (107/132 patients, 81.1%) had advanced HNSCC carcinomas (stages III and IV). Multiple LVLs were discovered in 24 subjects (18.2%) and no LVLs in 108 (81.8%) subjects. Fifty-five LVL biopsy specimens were obtained and assessed. Squamous cell carcinomas were detected in two patients, peptic esophagitis in 11 patients, gastric heterotopic mucosa in two patients, hyperplasia in two patients, and low- and high-grade dysplasia in three patients. Conclusion. Although only two patients with synchronous primary carcinomas were found among the patients, esophagoscopy should be recommended after detection of HNSCC to exclude secondary esophageal carcinoma or dysplasia.

Highlights

Patients with squamous cell carcinomas of the head and neck (HNSCC) region show a predisposition to developing second primary squamous cell carcinomas in the aerodigestive tract [1,2,3]
While the risk of the existence of a second primary tumor in another area of the head or neck varies from 16% to 36%, the incidence of esophageal squamous cell carcinoma (SESCC) in patients with HNSCC varies from 1% to 17% [3, 4]
In contrast to standard white light esophagoscopy, which observes the macroscopic appearance of mucosal lesions without any enhancement, chromoendoscopy (Lugol’s solution chromoendoscopy or methylene blue contact endoscopy) and “electronic chromoendoscopy” enable detection of lesions that are not otherwise visible

Summary

Introduction

Patients with squamous cell carcinomas of the head and neck (HNSCC) region show a predisposition to developing second primary squamous cell carcinomas in the aerodigestive tract [1,2,3]. The identification of early esophageal lesions localized and limited only to the mucosa and submucosa may enhance the cure rate for patients with HNSCC [1, 7,8,9,10,11]. These esophageal lesions can potentially be completely removed by endoscopic mucosal resection [7, 8, 10, 12]. In contrast to standard white light esophagoscopy, which observes the macroscopic appearance of mucosal lesions without any enhancement, chromoendoscopy (Lugol’s solution chromoendoscopy or methylene blue contact endoscopy) and “electronic chromoendoscopy” (autofluorescence or narrow-band imaging) enable detection of lesions that are not otherwise visible

Methods

Results

Discussion

Conclusion