Abstract
BackgroundSecond primary cancer of the esophagus is frequent in head and neck patients, especially in high-risk populations, and has a great impact on the prognosis. Although Positron emission tomography (PET)/computed tomography (CT) scan is commonly conducted in head and neck patients, its ability to detect early esophageal cancer is limited. Narrow-band imaging endoscopy is an accurate and convenient technique for esophageal examination. We aimed to compare PET/CT scan and narrow-band imaging endoscopy for the detection of esophageal cancer in head and neck cancer patients.MethodsFrom November 2015 to November 2018, all head and neck cancer patients who underwent both PET/CT scan and narrow-band imaging endoscopy at Changhua Christian Hospital were retrospectively enrolled. Descriptive statistics, receiver operating characteristic curve analysis, logistic regression analysis, independent Student’s t-test, and Kaplan–Meier survival analysis were conducted with MedCalc Statistical Software.ResultsA total of 147 subjects were included in the analysis; suspicious esophageal lesions were identified by PET/CT scan in 8 (5.44%) and by narrow-band imaging in 35 (23.81%). The final pathologic diagnoses were esophageal squamous cell carcinoma in 10 and high-grade dysplasia in 5. The respective sensitivity, specificity, and area under the curve for detecting suspicious esophageal lesions were 33.33, 97.73%, and 0.655 for PET/CT scan, and 100.0, 84.85%, and 0.924 for narrow-band imaging endoscopy. Hypopharyngeal or laryngeal location of the primary head and neck cancer was the only risk factor for developing second primary esophageal cancer.ConclusionsPET/CT scan was inferior to narrow-band imaging endoscopy in detecting second primary esophageal cancer in head and neck cancer patients. In addition to PET/CT scan, narrow-band imaging endoscopy should be considered in head and neck patients at high risk for developing second primary esophageal cancer.
Highlights
Second primary cancer of the esophagus is frequent in head and neck patients, especially in high-risk populations, and has a great impact on the prognosis
In the present retrospective study, we aimed to evaluate the role of Positron emission tomography (PET)/computed tomography (CT) scan, in comparison with narrow-band imaging (NBI) endoscopy, in detecting Second primary cancers (SPC) of the esophagus in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients
Suspicious esophageal lesions were found by PET/CT scan in 8 (5.44%) and by NBI endoscopy in 35 (23.81%)
Summary
Second primary cancer of the esophagus is frequent in head and neck patients, especially in high-risk populations, and has a great impact on the prognosis. We aimed to compare PET/CT scan and narrow-band imaging endoscopy for the detection of esophageal cancer in head and neck cancer patients. In Taiwan, HNC accounts for approximately 10% of all cancers, with a 7.3fold higher incidence in men than in women, and about 8.2% of all cancer-related death in both sexes [2]. Detection of SPC of the esophagus, endoscopic resection, and implementation of pretreatment endoscopic screening policy had been shown to significantly improve the survival rates of HNC patients, especially among Asians [9, 12, 13, 15]
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