Pharyngeal cancer during endoscopy

Drs. Takemura, Doyama, and Nakanishi

Hiroyoshi Nakanishi, MD from Ishikawa Prefectural Central Hospital in Ishikawa, Japan reports on his Original Article published recently in GIE titled “Detection of pharyngeal cancer in the overall population undergoing upper GI endoscopy by using narrow-band imaging: a single-center experience, 2009–2012.”

Narrow-band imaging (NBI) including magnifying endoscopy is very useful for the detection and diagnosis of early pharyngeal cancer. This study retrospectively reviewed the rate of detection of pharyngeal cancer during routine upper gastrointestinal (UGI) endoscopy using NBI and to evaluate the rates of detection according to the reason for endoscopy.

Pharyngeal cancer is usually diagnosed at an advanced stage and therefore has a relatively poor prognosis. However, pharyngeal cancer diagnosed at an early stage may be treatable by endoscopic resection without long-term dysfunction. Is it meaningful to examine the pharynx during routine UGI endoscopy? One of the aims of this study was to find the answer to this clinical question. We evaluated a large population (n=11,050) with almost no selection bias, hence it will be a better representative of prevalence rates.

The rate of detection of pharyngeal cancer was 0.26% (29/11,050) in the overall population undergoing UGI endoscopy by using NBI (Table 3), and at least 65.8% of the detected cancerous lesions had a pathological diagnosis of superficial cancer. Observation of the pharynx by using NBI in patients with previous head and neck cancer, esophageal cancer, or pharyngeal discomfort is very important. Moreover, even in the screening UGI endoscopy, we did detect 10 cases (0.11%) of pharyngeal cancer and the patients were all male. Being male is an independent risk factor for pharyngeal cancer, thus male subjects may constitute a target high-risk group. Although high, the sensitivity of NBI is not perfect. There may be some false negatives. We would like to clarify the rate and characteristics of missed lesions, and improve the examination method in the future studies.

Emura et al wrote, “Endoscopic diagnosis and curative treatment for pharyngeal cancer by GI endoscopists are not a dream, but can be a reality” (Gastrointest Endosc 2013;78:143-9). We really have great sympathy for these words. We believe that our findings may have a significant impact on clinical practice.

Find this abstract online here.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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