Narrow Band Imaging with Magnification Can Pick Up Esophageal Squamous Cell Carcinoma More Efficiently Than Lugol Chromoendoscopy in Patients after Chemoradiotherapy
Aim. Little is known about the usefulness of narrow band imaging (NBI) for surveillance of patients after chemoradiotherapy for esophageal neoplasia. Its usefulness in detecting esophageal squamous cell carcinoma (SCC) or high-grade intraepithelial neoplasia (HGIN) in these patients was retrospectively compared to Lugol chromoendoscopy. Patients and Methods. We assessed the diagnostic ability of NBI with magnification based on the biopsy specimens obtained from iodine-unstained lesions. Seventy-two iodine-unstained lesions were biopsied and consecutively enrolled for this study. The lesions were divided into NBI positive and NBI negative. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of NBI with magnification and PPV of Lugol chromoendoscopy was calculated using histological assessment as a gold standard. Results. Forty-six endoscopic examinations using NBI with magnification followed by Lugol chromoendoscopy were performed to 28 patients. The prevalence of SCC and HGIN was 21.4%. Sensitivity, specificity, PPV, NPV, and accuracy of NBI were 100.0%, 98.5%, 85.7%, 100%, and 98.6%, respectively. On the contrary, PPV of Lugol chromoendoscopy were 8.3%. Compared to Lugol chromoendoscopy, NBI with magnification showed equal sensitivity and significantly higher PPV ( ). Conclusion. NBI with magnification would be able to pick up esophageal neoplasia more efficiently than Lugol chromoendoscopy in patients after chemoradiotherapy. 1. Introduction Posttreatment surveillance of esophageal squamous cell carcinoma (SCC) after chemoradiotherapy (CRT) is very important because early detection of local persistence or recurrence makes it possible to prevent delay in change of treatment. In addition, metachronous SCC of esophagus often develops in the patients with past history of esophageal SCC [1]. However, differential diagnosis between local persistence, recurrence, and metachronous SCC or normal posttherapeutic sequelae such as mucositis and fibrosis often becomes a problem after CRT [2]. Indeed, in our experience, many iodine-unstained areas which were proven to be nonneoplastic lesions by biopsy were frequently observed in patients after CRT for esophageal carcinoma. Lugol chromoendoscopy is the gold standard for detecting esophageal SCC [3–6]. Lugol staining is based on a chemical reaction between iodine and the glycogen which is contained in normal epithelial cell microgranules in the stratum spinosum [7]. Dysplastic and cancerous cells are not stained by Lugol’s solution because they do not contain
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