Narrow Band Imaging for Esophageal Surveillance in Patients with Head and Neck Cancers

Abstract

Backgrounds: Squamous dysplasia and carcinoma in situ in the esophagus can be visualized by Lugol chromoendoscopy. However, the Lugol staining method often leads to pain and discomfort because iodine causes severe mucosal irritation. The narrow band imaging (NBI) system is a novel technology based on visualization of microvasculature and mucosal patterns. The aim of this study is to assess the feasibility of the NBI system for screening for esophageal cancer in patients with head and neck cancers. Patients and Methods: Patients with head and neck squamous cell carcinoma were examined by NBI esophageal endoscopy followed by chromoendoscopy using iodine dye from April 2006 to November 2007. All procedures were performed using a magnifying endoscope (GIF-Q240Z or GIF-FQ260Z, Olympus Co.). If abnormal mucosal areas (well demarcated brownish area) were identified under the non-magnifying NBI and if scattered brownish dots were observed within the lesion under the magnifying NBI, we defined the lesion as being abnormal. After NBI endoscopy, Lugol idodine solution was sprayed over the entire esophageal mucosa. A well demarcated, unstained lesion was defined as a Lugol-voiding lesion (LVL). Biopsy specimens were taken when the LVL was > 5 mm in size, and divided into 4 categories: squamous cell carcinoma (SCC); high grade intraepithelial neoplasia (HGN); low grade intraepithelial neoplasia (LGN); and lesion without atypia (no atypia). The detection of esophageal SCC and HGN were evaluated. Results: A total of 109 patients were enrolled. The median age of the patients was 64 years (range, 29-86 years), and approximately three fourths of all patients were male. Fourteen superficial lesions were detected by NBI endoscopy. Of these, 6 lesions were diagnosed as SCC and 1 lesion as HGN. Among the patients without positive findings by NBI endoscopy, LVL > 5 mm was shown in 12 lesions. Five lesions were diagnosed as LGN and 7 leisons as no atypia. There was no esophageal SCC or HGN in patients with normal findings by NBI endoscopy. Conclusions: NBI is useful for screening for esophageal squamous cell carcinoma in patients with head and neck cancer. By introducing the NBI system, chromoendoscopy using iodine dye may be necessary less often for the diagnosis of superficial esophageal squamous cell carcinoma.