Case of pharyngeal cancer not detected during preoperative transoral endoscopy with narrow band imaging.

We herein report a case of pharyngeal cancer that was not detected during preoperative transoral endoscopy with narrow band imaging (NBI). A 61-year-old female was referred to our hospital for further evaluation of a pharyngeal lesion. Endoscopy revealed a small, elevated lesion, approximately 7 mm in size, at the right pyriform sinus. We performed endoscopic resection to remove this lesion under general anesthesia based on the biopsy results. Intraoperatively, we detected another tumor in the left oropharyngeal wall with Lugol staining after insertion of a curved laryngoscope. Although this lesion was ≥20 mm in diameter, we were unable to detect it during preoperative transoral endoscopy with NBI and white light imaging. We performed endoscopic treatment for this lesion 2 months later. The pathological diagnosis was pharyngeal cancer; the lesion had low vascularity. This case report provides an example of false-negative endoscopy with NBI. Although transoral endoscopy with NBI has improved the early diagnosis of superficial squamous cell carcinomas of the head and neck, pharyngeal cancers that are less vascular may be missed with NBI.

Detection of pharyngeal cancer in the overall population undergoing upper GI endoscopy by using narrow-band imaging: a single-center experience, 2009-2012.

BACKGROUND: Nonmagnifying observation by using narrow-band imaging (NBI) is useful for detecting pharyngeal lesions. Magnifying observation by using NBI can distinguish between cancerous and noncancerous lesions and is therefore useful for the early detection of pharyngeal cancer. OBJECTIVE: To evaluate the usefulness of observation of the pharynx by using NBI in the overall population undergoing upper GI endoscopy. DESIGN: Retrospective study. SETTING: Single tertiary referral center. PATIENTS: A total of 11,050 upper GI endoscopies between January 2009 and December 2012. INTERVENTIONS: Observation of the pharynx by using NBI. MAIN OUTCOME MEASURES: The rate of detection of pharyngeal cancer, the rates of detection according to the reason for endoscopy, and the types of cancers detected. RESULTS: Thirty-eight cancerous lesions were detected in 29 patients (0.26%, 29/11,050). The rate of detection of pharyngeal cancer was significantly higher in patients with a history of head and neck cancer (9.7%, 3/31) or a history of esophageal cancer (3.5%, 10/282). In patients undergoing endoscopy for screening, pharyngeal discomfort, and a history of gastric cancer, the rates of detection of pharyngeal cancer were 0.11% (10/8872), 1.1% (3/265), and 0.19% (3/1600), respectively. Two patients (6.9%) were female. One had a history of esophageal cancer, and the other had pharyngeal discomfort. LIMITATIONS: Single-center, retrospective study. CONCLUSIONS: Observation of the pharynx by using NBI in patients with previous head and neck cancer or esophageal cancer or who have pharyngeal discomfort is very important. Moreover, pharyngeal cancer was certainly found in the male patients undergoing screening endoscopy, although the rate was lower.