Image-enhanced endoscopy for detection of second primary esophageal neoplasms in patients with hypopharyngeal cancer: Prevalence, risk factors, and characteristics

Abstract

Background: Esophageal second primary neoplasms (ESPNs) are common in hypopharyngeal squamous cell carcinoma (HPSCC) patients and are associated with poor prognoses. The effectiveness of image-enhanced endoscopy (IEE) has not been well established. Methods: We reviewed the patients between April 2016 and April 2018 with HPSCC receiving ESPNs screening via white-light imaging, narrow-band imaging, and Lugol chromoendoscopy. Results: Of 99 eligible patients, ESPNs prevalence was 31%. Of the 69 patients assigned to the follow-up group, 23 with positive findings showed significantly increased previous histories of second primary malignancies in the upper aerodigestive tract. Among them, patients without symptoms at the time of IEE screening showed less advanced T stages and higher percentages of receiving minimal invasive therapy. Conclusion: The present study represented the clinical utility of routine IEE screening in HPSCC patients and proposed routine surveillance may help identify and properly manage early-stage ESPN.

Is it possible to increase detection rate of esophageal precancer or cancer lesions in the high-risk population?

“…Similar to patients with Barrett’s esophagus prone to developing EIN and EC during their lives, 5 in the current study, the authors found that patients with past or newly-diagnosed HPSCC had a higher risk of synchronous EIN/EC or subsequent development of EIN/EC. 9 As shown in the current study, 9 more than one-fourth of the newly-diagnosed HPSCC patients have a synchronous EIN/EC (10% for invasive EC and 16.7% for EIN). 9 It is very important that all patients with a newly-diagnosed HPSCC should undergo the detailed and thorough evaluation of the upper aerodigestive tract and lung, because of high incidence or high prevalence (>25%) of synchronous or metachronous SCC in oral cancer patients based on the current study.…”

“…9 As shown in the current study, 9 more than one-fourth of the newly-diagnosed HPSCC patients have a synchronous EIN/EC (10% for invasive EC and 16.7% for EIN). 9 It is very important that all patients with a newly-diagnosed HPSCC should undergo the detailed and thorough evaluation of the upper aerodigestive tract and lung, because of high incidence or high prevalence (>25%) of synchronous or metachronous SCC in oral cancer patients based on the current study. 9 In fact, surveillance programs of the upper aerodigestive tract and lung cancers are mandatory to detect synchronous or metachronous SCC, including EC at early stages.…”

“…8 Additionally, among 69 patients with history of HPSCC, the authors found that one-third of patients develop secondary primary EIN or EC during the follow-up. 9 Seven patients (30.4%) were Tis; 47.8% were T1 (n = 11); 8.7% were T2 (n = 2); 13% were T3 (n = 3); and none was T4. 9 Furthermore, more than two-thirds (69.6%, n = 16) of patients were asymptomatic.…”

“…9 Seven patients (30.4%) were Tis; 47.8% were T1 (n = 11); 8.7% were T2 (n = 2); 13% were T3 (n = 3); and none was T4. 9 Furthermore, more than two-thirds (69.6%, n = 16) of patients were asymptomatic. All suggest that the application of EGDS with IEE for screening in HPSCC patients, regardless of past history and newly diagnosed, is a very effective tool for the clinical utility.…”

“…We are happy to introduce the recent publication in the October issue of the Journal of the Chinese Medical Association , and the authors attempted to evaluate the effectiveness of image-enhanced endoscopy (IEE) in the detection of EIN or EC for the high-risk population, such as history of hypopharyngeal squamous cell carcinomas (HPSCC) and newly-diagnosed HPSCC. 9…”