Evaluating synchronous esophageal cancer in head and neck cancer patients using Lugol dye chromoendoscopy

Routine screening for esophageal cancer in head and neck cancer patients in Thailand is controversial, because of concerns regarding the screening methods and cost effectiveness. Since Lugol dye chromoendoscopy is an effective technique for early detection of squamous cell carcinoma of the esophagus, the objectives of the present study are to evaluate the synchronous esophageal cancer in head and neck cancer patients and the effectiveness of Lugol dye chromoendoscopy for routine screening.

All diagnosed patients with head and neck cancer between September 1, 2009 and June 30, 2011 were enrolled into the study. Both conventional esophagoscopy and Lugol dye chromoendoscopy were done. The incidence of esophageal cancer was calculated. A diagnostic statistical analysis was done to compare the diagnostic properties between conventional esophagoscopy and Lugol dye chromoendoscopy. Univariate and multivariate logistic regression analyses were used to find significant factors associated with esophageal cancer in this study.

Eighty-nine head and neck cancer patients were enrolled in this study. The incidence of esophageal cancer in head and neck cancer patients was 12.4% (11/89). Conventional esophagoscopy found a highly suspicious malignant lesion in only six patients, while the Lugol dye chromoendoscopy detected all 11 esophageal cancers. The sensitivity and specificity for conventional esophagoscopy were 54.5% and 100%, respectively, andfor Lugol dye chromoendoscopy were 100% and 70.5%, respectively. The three significant factors that increased the likelihood of synchronous esophageal cancer from univariate analysis were age less than 50 years, presence of dysphagia, and an unstained Lugol dye area ≥10 mm. Howeve, these factors were not statistically significant by multivariate analysis.

Lugol dye chromoendoscopy is a promising tool to enhance the diagnosis of esophageal cancer among head and neck cancer patients.