Multiple Lugol‐unstained lesions predict higher cumulative risk of malignance in the esophagus

Abstract

Background and Aim:The impact of the presence of multiple Lugol-unstained lesions (LULs) in the esophagus on the risk of having severe dysplasia and above (SDA) lesions among asymptomatic individuals is unknown. Methods: We collected demographic factors, behavioral variables, and features of LULs from 1073 participants who were biopsied at baseline endoscopic screening in a population-based screening trial, and these individuals were followed over a median time of 7 years. Outcome events were defined as SDA identified at screening, at reexamination, or during follow-up. "Multiple LULs" were defined as ≥ 2 LULs found in the entirety of the esophagus. Multivariable logistic regression models were fitted to assess the effect of "multiple LULs" on the cumulative risk of SDA. Results: There were 147 SDA cases in the current study. After adjustment for potential risk factors and endoscopic features of LULs, the presence of "multiple LULs" slightly increased the cumulative risk of having SDA with no statistical significance (adjusted odds ratio [OR] = 1.26; 95% confidence interval [CI] [0.85, 1.88]). Further stratified analysis showed that this association was strong among subjects with small LULs (≤ 5 mm) (adjusted OR = 3.29; 95% CI [1.39, 7.79]). However, no such association was observed in subjects with larger LULs (adjusted OR = 0.99; 95% CI [0.63, 1.55], P interaction = 0.022). Conclusions: The presence of "multiple small LULs (≤ 5 mm)" in chromoendoscopy indicates a higher cumulative risk of having SDA in the esophagus. We recommend biopsies be taken and surveillance be maintained at a more active level in individuals with relatively small but multiple LULs.

Effectiveness of Endoscopic Screening on Esophageal Cancer Incidence and Mortality: A 9-Year Report of the Endoscopic Screening for Esophageal Cancer in China (ESECC) Randomized Trial

“…33 However, our previous studies have shown that nondysplastic Lugol-unstained lesions (ND-LULs) could be the initial stage of ESCC, and endoscopic features of LULs independently indicate the risk of progression of precursor lesions. [34][35][36][37][38] Although we have taken these factors into account in the surveillance of the ESECC trial, the above commonly adopted pathology-based criteria would still have resulted in insufficient surveillance of ND-LULs to some extent, and therefore dilute the screening effect in this trial.…”

How should extra‐large Lugol‐unstained lesions of the esophagus be treated? Results from a population‐based cohort study

“…Discrepancies were resolved by discussion. Based on review of the literature and our previous study results, we assessed 6 endoscopic features in this study, including the size of LULs, mosaic staining, irregularity, sharpness of the border, dark staining border, and numbers of LUL in the entire esophagus 14,18,19 . The features were extracted from the LUL with the highest grade pathologic diagnosis if more than one LUL were found in the esophagus.…”

“…Based on review of the literature and our previous study results, we assessed 6 endoscopic features in this study, including the size of LULs, mosaic staining, irregularity, sharpness of the border, dark staining border, and numbers of LUL in the entire esophagus. 14,18,19 The features were extracted from the LUL with the highest grade pathologic diagnosis if more than one LUL were found in the esophagus. Details regarding the measurements of endoscopic features of LULs are presented in the supplementary material (supplementary material: definition and Figure S1).…”