Title: Multicenter Prospective Randomized Controlled Study On the Detection and Diagnosis of Superficial Squamous Cell Carcinoma By Back-to-Back Endoscopic Examination of Narrowband Imaging and White Light Observation
Abstract: Background: White light sourced from a xenon lamp has been used in conventional endoscopic examination. While narrowband imaging (NBI), a new optical technique, is expected to improve the detection and diagnostic accuracy of gastrointestinal neoplasm, on-site and real-time diagnostic power is obscure. Clinical diagnoses of squamous cell carcinoma of the esophagus (ESCC) and the head-and-neck region (HNSCC) are usually made at advanced stages, resulting in poor prognoses. Although lugol chromoendoscopy can be used to detect ESCC at an early stage, it causes severe chest pain and discomfort and is not used for screening for HNSCC because of the risk of aspiration. Objective: The primary aim of this multicenter randomized prospective controlled study was to compare real-time detection rates of superficial cancer between NBI and white light observation (WLO). The secondary aim was to evaluate the diagnostic accuracy of these techniques. Subjects and Methods: Because patients with ESCC frequently develop multiple intra-esophageal cancers and HNSCCs, they are good models for cancer screening. Subjects in this study were the patients 1) with newly diagnosed ESCC or previously treated ESCC by EMR and 2) without any previous radiotherapy or chemotherapy for ESCC or HNSCC. Patients were randomly assigned to NBI followed by WLO or to WLO followed by NBI. This study design was based on the recommendations of the Standards for Reporting of Diagnostic Accuracy initiative. All examinations were performed using magnifying endoscopy. For comparative purposes, histological confirmation of ESCC or HNSCC was used as the standard. Lesions that exhibited well-demarcated brownish surfaces as well as irregular microvascular patterns were diagnosed as superficial cancers. The real-time diagnose on site was used in this study. Results: Three hundred and twenty patients with ESCC were randomly assigned to NBI followed by WLO (n = 162) or WLO followed by NBI (n = 158). In the first examination, the number of histologically-confirmed HNSCC and ESCC detected was greater for NBI than for WLO (HNSCC: 15 vs 1, p < 0.0001; esophagus: 101 vs 57, p < 0.0001). In the first examination, the diagnostic accuracy of NBI was greater than that of WLO (head-and-neck region: 89.7% vs 61.8%, esophagus: 90.2% and 55.3%, respectively). In the second examination, the diagnostic accuracy of NBI improved compared to that of WLO in the first examination, while that of WLO reduced. Conclusion: These results indicate that NBI may be useful as a standard examination for making accurate diagnoses of superficial ESCCs and HNSCCs.
Publication Year: 2007
Publication Date: 2007-04-01
Language: en
Type: article
Indexed In: ['crossref']
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Cited By Count: 20
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