Oesophageal Squamous Cell Carcinoma Screening Among High-Risk Patients: National Prospective Study of the French Digestive Endoscopy Society (SFED)

Abstract

Introduction. The oesophageal squamous cell carcinoma (car.) prevalence in high-risk patients (pts) and the interest of a systematic lugol staining during the oesophageal endoscopy in order to improve an earlier detection have not been evaluated in a large prospective study. The aim of this prospective study was to determine if and when the risk was important enough to justify a screening program. Patients and methods. The inclusion criterias were : no oesophageal symptoms either with old or recent head and neck or tracheobronchial squamous cell carcinoma (gr 1), or alcoholic chronic pancreatitis (gr 2), or alcoholic cirrhosis (gr 3), or alcohol and tobacco addicts with a medical follow up in an alimentary hygiene center (gr 4). Patients with contraindication for oesophagoscopy or for biopsies (oesophageal varices, major disorders of coagulation) were excluded. An oesophagoscopy was performed according to the following methods: meticulous oesophageal examination before and after staining by 20 ml of a lugol solution (2%) pulverized by a spray catheter. The tracking and the biopsies of the unstained areas were made 2 minutes after coloration. Results. From September 2000 to June 2003, 1097 pts (944 men, mean age 54.3 +/- 11 years) were included in 45 digestive endoscopy centers: 394 in the group 1, 76 in the group 2, 220 in the group 3, 407 in the group 4. The results after staining are given in the table. Before staining, 29 car., 6 high grade dysplasia (HGD), 3 low grade dysplasia (LGD) were observed. After staining, we found 29 others lesions: 6 car., 4 HGD, and 19 LGD. The prevalence of car. and HGD was finally respectively 3.2% and 0.8% versus 2.7% et 0.5% before staining. The lugol staining only gave a statistically significant advantage when we took LGD into account; the number of discovered lesions was in that case 6.1% versus 3.5 % (p<0.001). Conclusion. Only the group of patients with head and neck or tracheobronchial cancer presents a sufficient risk to justify a screening program. The lugol oesophageal staining did not improve significantly the sensibility of detection of early oesophageal cancers, but allows selecting a group with a low grade of dysplasia which is probably a very high risk population.