Abstract
BackgroundEarly 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.MethodsA systematic review of all available databases was performed to find all Lugol chromoendoscopy screening studies.ResultsFifteen 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%.ConclusionOur 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.
Highlights
Part of the mortality of patients treated for head and neck squamous cell carcinoma (HNSCC) is caused by the occurrence of second primary tumors (SPTs).[1]
A second aim was to investigate whether current data from non-Asian patient populations provide enough evidence to justify Lugol chromoendoscopy screening for esophageal-SPTs in patients with HNSCC in the Western world
The diagnostic yield of Lugol chromoendoscopy in patients with oral cavity tumors was 7.2% (47 of 637, 95% CI: 3.2-11.2)
Summary
Part of the mortality of patients treated for head and neck squamous cell carcinoma (HNSCC) is caused by the occurrence of second primary tumors (SPTs).[1]. The occurrence of esophageal-SPTs in patients with HNSCC is often explained by field cancerization of the entire upper aerodigestive tract.[14,15] The theory of field cancerization states that the mucosal field around the index tumor possesses subtle histologic and genetic changes that increase the risk of synchronous and metachronous malignancies These subtle tissue changes are thought to be the effect of exposure to accumulating carcinogens (eg, alcohol and tobacco).[10]. When combined with narrow band imaging (NBI), it is reported to have a sensitivity of 94.7% and a specificity of 90.4% to detect early stage esophageal lesions.[24,25] Based on these results, many clinics in Asia implemented esophageal-SPT screening in patients with HNSCC.[10] Recently, the French Society of Otorhinolaryngology recommended routine flexible white-light esophageal endoscopy in the workup of patients with oropharyngeal and hypopharyngeal HNSCC or chronic alcohol use.[13] The addition of Lugol’s stain was recommended. A second aim was to investigate whether current data from non-Asian patient populations provide enough evidence to justify Lugol chromoendoscopy screening for esophageal-SPTs in patients with HNSCC in the Western world
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