Image‐enhanced endoscopy for detection of second primary neoplasm in patients with esophageal and head and neck cancer: A systematic review and meta‐analysis

Abstract

Image-enhanced endoscopy is helpful for screening of a second primary neoplasm in patients with esophageal and head and neck cancer. The purpose of this meta-analysis was to determine the diagnostic efficacy of white-light imaging (WLI), narrow band imaging (NBI), and Lugol chromoendoscopy for second primary neoplasm detection. A review of the PubMed/Cochrane databases up to May 2014 was performed. Meta-analysis was done by Meta-DiSc software and the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A total of 4918 patients from 16 prospective and randomized trials were enrolled. For WLI, NBI, and Lugol chromoendoscopy, the pooled sensitivities were 53% (95% confidence interval [CI] = 48% to 59%), 87% (95% CI = 83% to 90%), and 88% (95% CI = 85% to 91%), respectively; the pooled specificities were 99% (95% CI = 98% to 99%), 95% (95% CI = 94% to 96%), and 63% (95% CI = 61% to 66%), respectively; and the areas under the receiver-operating characteristic (ROC) curve were 66%, 97%, and 82%, respectively. NBI endoscopy has the most highly accurate diagnostic performance for detection of second primary neoplasms in high-risk patients. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2343-E2349, 2016.

Endoscopic screening for synchronous esophageal neoplasia among patients with incident head and neck cancer: Prevalence, risk factors, and outcomes

“…[9][10][11][12][13][14] One explanation for differences in ESCN prevalence or detection rates was the diagnostic modality. 15 Another explanation for the wide difference in incidence was differences in definition of ESCN across studies. 23 In a recent meta-analysis, NBI appeared to have the highest diagnostic accuracy in detecting ESCN (97% sensitivity and 94% specificity), while Lugol chromoendoscopy had better diagnostic accuracy (sensitivity 88%, specificity 63%) than white-light image.…”

“…6 Alcohol, cigarette and betel nut have been identified as risk factors for both HNSCC and esophageal squamous-cell carcinoma (SCC) 7,8 and this may explain the high incidence of esophageal SCC among patients with HNSCC. 15 Because such examinations are not performed without costs, it might be advisable to identify the subpopulations of NHSCC patients who might be at higher risk. [9][10][11][12][13][14] Typical symptoms of esophageal SCC such as dysphagia and odynophagia can be misconstrued as the side effects of HNSCC treatments, leading to delays in diagnosis.…”

Early detection of esophageal second primary tumors using Lugol chromoendoscopy in patients with head and neck cancer: A systematic review and meta‐analysis

“…The risk of esophageal cancer after HNSCC treatment is an 8‐fold to 22‐fold greater than in the general population . These SPTs are often diagnosed in advanced stages, which lead to a very low 5‐year survival rate for affected patients . The prevalence of esophageal‐SPTs in patients with HNSCC is estimated to range from 0% to 22% …”

“…The theory of field cancerization states that the mucosal field around the index tumor possesses subtle histologic and genetic changes that increase the risk of synchronous and metachronous malignancies. These subtle tissue changes are thought to be the effect of exposure to accumulating carcinogens (eg, alcohol and tobacco) …”

“…[7][8][9] These SPTs are often diagnosed in advanced stages, which lead to a very low 5-year survival rate for affected patients. 6,[10][11][12] The prevalence of esophageal-SPTs in patients with HNSCC is estimated to range from 0% to 22%. 13 The occurrence of esophageal-SPTs in patients with HNSCC is often explained by field cancerization of the entire upper aerodigestive tract.…”