Narrow-band imaging vs Lugol chromoendoscopy in screening for esophageal squamous cell neoplasia: a randomized trial.
Pol Arch Intern Med
; 133(10)2023 10 26.
Article
en En
| MEDLINE
| ID: mdl-36916462
INTRODUCTION: To date, there is no established optimal method for endoscopic detection of esophageal squamous cell neoplasia in highrisk individuals. OBJECTIVES: We aimed to compare the performance of narrowband imaging (NBI) and Lugol chromoendoscopy in screening for esophageal neoplasia among patients with a history of treatment for head and neck squamous cell cancer (HNSCC). PATIENTS AND METHODS: We randomly assigned 300 patients who had completed curative treatment for HNSCC at least 1 year prior to the inclusion to undergo either NBI or Lugol endoscopy (2:1 ratio). Following whitelight examination of the esophagus, the assigned imaging study was performed, and biopsies were taken from any suspicious lesions identified using NBI or Lugol chromoendoscopy. The primary end point was positive predictive value (PPV) of the biopsied lesion for a diagnosis of esophageal neoplasia (highgrade intraepithelial neoplasia [HGIEN] or invasive esophageal squamous cell carcinoma [ESCC]). The secondary end points included the number of biopsied lesions, duration of esophagus examination, and endoscopy tolerance. RESULTS: In 294 patients included in the final analysis (NBI, n = 204; Lugol chromoendoscopy, n = 90), we diagnosed 3 ESCCs (1.02%) and 2 HGIENs (0.68%). The PPV of NBI and Lugol chromoendoscopy in perlesion analysis was 7.69% (95% CI, 0.94%-25.1%) and 8.11% (95% CI, 1.7%-21.9%), respectively (P >0.99). NBI outperformed Lugol chromoendoscopy in terms of the rate of patients requiring biopsy (12.75% vs 41.11%; P = 0.003), duration of esophagus examination (3.5 min vs 5.15 min; P <0.001), and endoscopy tolerance assessed on the visual analog scale (25 mm vs 36.5 mm; P = 0.002). CONCLUSIONS: With a PPV comparable to that of Lugol chromoendoscopy, but a lower number of biopsies required, shorter examination time, and better patient tolerance, NBI could be considered the primary screening method for ESCC in patients with HNSCC.
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Neoplasias Esofágicas
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Carcinoma de Células Escamosas
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Carcinoma de Células Escamosas de Esófago
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Neoplasias de Cabeza y Cuello
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Prognostic_studies
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Screening_studies
Idioma:
En
Revista:
Pol Arch Intern Med
Año:
2023
Tipo del documento:
Article