Occult Dysplasia is Disclosed by Lugol Chromoendoscopy in Alcoholics at High Risk for Squamous Cell Carcinoma of the Esophagus

Fagundes, Renato Borges; Barros, Sérgio Gabriel Silva de; Pütten, Antonio Carlos Kruel; Mello, Evandro S.; Wagner, Mário Bernardes; Bassi, Luiz Augusto Peukert Bassi; Bombassaro, Marlos Antonio; Gobbi, Dalia; Souto, Eliana B.

doi:10.1055/s-1999-122

Cited by 94 publications

(54 citation statements)

References 13 publications

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“…This high percentage compares well or even surmounts the rates observed in previous studies (Makuuchi et al, 1996;Meyer et al, 1997;Fagundes et al, 1999;Tincani et al, 2000;Petit et al, 2001) and provides strong evidence for the efficacy of the screening protocol used in this study. Various alternative screening strategies have been described.…”

Section: Discussionsupporting

confidence: 89%

“…In order to detect early lesions even in a macroscopically normal looking and staining oesophagus (Fagundes et al, 1999), we took multiple biopsies according to a systematic endoscopic biopsy protocol and found that 6.8% (10 out of 148) of the patients biopsied had oesophageal squamous cell dysplasias (synonym: intraepithelial neoplasias; Gabbert et al, 2000;Schlemper et al, 2000a -c). This high percentage compares well or even surmounts the rates observed in previous studies (Makuuchi et al, 1996;Meyer et al, 1997;Fagundes et al, 1999;Tincani et al, 2000;Petit et al, 2001) and provides strong evidence for the efficacy of the screening protocol used in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Various alternative screening strategies have been described. These include brush-capsule cytology (LeoniParvex et al, 2000), biannual oesophageal endoscopy without Lugol staining (Petit et al, 2001), Lugol chromoendoscopy with (Fagundes et al, 1999) or without random biopsies (Shiozaki et al, 1990;Makuuchi et al, 1996), (auto)fluorescence endoscopy (Haringsma et al, 2001) or tri-modal spectroscopy (Georgakoudi et al, 2001). These different strategies have, however, not yet been compared in controlled clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…Drawbacks of Lugol staining are the low yield of neoplasia in small unstained areas (51% ESCC risk in unstained areas of 55 mm) and the missing of normal staining intra-epithelial neoplasias. By taking two random biopsies in the middle of the oesophagus, Fagundes et al (1999) observed intra-epithelial neoplasias in 7 out of 165 (4.2%) alcoholic smokers Molecular and Cellular Pathology Metachronous: oesophageal dysplasia was diagnosed 6 months after the diagnosis of HNC.…”

Section: Discussionmentioning

confidence: 99%

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Screening for oesophageal neoplasia in patients with head and neck cancer

et al. 2002

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Due to advanced disease at the time of diagnosis the prognosis of oesophageal cancer is generally poor. As mass screening for oesophageal cancer is neither feasible nor reasonable, high-risk groups should be identified and surveilled. The aim of this study was to define the risk of oesophageal cancer in patients with (previous) head and neck cancer. A total of 148 patients with (previous) head and neck cancer were prospectively screened for oesophageal cancer by video-oesophagoscopy and random oesophageal biopsies. Even in a macroscopically normal looking oesophagus, four biopsy specimens were taken every 3 cm throughout the entire length of the squamous oesophagus. Low-or high-grade squamous cell dysplasia was detected histologically in 10 of the 148 patients (6.8%). All but one dysplasias were diagnosed synchronously with the head and neck cancers. In addition, oesophageal squamous cell carcinoma was diagnosed in 11 of the 148 patients (7.4%). Most invasive cancers (63.6%) occurred metachronously. The risk of squamous cell neoplasia of the oesophagus is high in patients with (previous) head and neck cancer. Surveillance is recommended in this high-risk group.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Screening for oesophageal neoplasia in patients with head and neck cancer

et al. 2002

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“…In the current study, patients were selected with esophageal symptoms and 86 (10.6%) patients were observed to have dysplasia/early carcinoma, among whom 19 (2.3%, 19/812) cases had severe dysplasia/early carcinoma. The detection rate of severe dysplasia/early carcinoma almost reached that of the high-risk population (13)(14)(15)(16)(17). In this study, these patients were divided into three groups according to symptoms, and 8.3% patients who had reflux, 17.2% patients who had dysphagia, and 15.8% patients who had globus sensation, were also observed to have dysplasia/early ESCC.…”

Section: A B Cmentioning

confidence: 79%

Lugol chromoendoscopic screening for esophageal dysplasia/early squamous cell carcinoma in patients with esophageal symptoms in low-risk region in China

Shao

et al. 2015

Oncology Letters

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Abstract. Detection of esophageal dysplasia/early esophageal squamous cell carcinoma (ESCC) is essential for improving 5-year survival. The aim of this prospective study was to evaluate whether Lugol chromoendoscopy improves the detection of esophageal dysplasia/early ESCC in patients with esophageal symptoms in a low-incidence region in China. Eligible patients were randomly assigned into two groups who received routine endoscopy or Lugol chromoendoscopy. During endoscopy, between one and five biopsies were taken from visible lesions for routine endoscopy, or unstained areas of >0.5 cm in diameter for Lugol chromoendoscopy. In total, 812 patients were enrolled, 395 for routine endoscopy and 417 for Lugol chromoendoscopy. The overall detection rate of esophageal dysplasia/early ESCC was 10.6% (86/812), the detection rates were 7.3% (29/395) and 13.7% (57/417) in routine and chromoendoscopy groups, respectively (χ 2 =8.58, P=0.003). The detection rates were 8.3% (48/580), 17.2% (17/99) and 16.5% (22/133), respectively, in patients with reflux, dysphagia and globus sensation symptoms. In the chromoendoscopy group, 213 patients had unstained lesions of >0.5 cm, the detection rates of dysplasia/early carcinoma were 5.3% (4/76) in those with lesions of 0.5-1.0 cm, and 37.2% (51/137) in those with lesions >1.0 cm (χ 2 =21.46, P<0.001). These results indicate that Lugol chromoendoscopy improves the detection rate of esophageal dysplasia/early carcinoma in patients with esophageal symptoms compared with routine endoscopy. We propose that Lugol chromoendoscopy must therefore be considered in addition to routine endoscopy in patients with esophageal symptoms.

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