Videofluoroscopic Swallow Examination Does Not Accurately Detect Cricopharyngeal Radiation Strictures

Area of Science:

• Oncology
• Radiology
• Gastroenterology

Background:

• Dysphagia is a common complication after head and neck cancer (HNC) radiotherapy.
• Videofluoroscopy (VF) is the standard imaging modality for evaluating dysphagia in HNC survivors.
• The diagnostic accuracy of VF for pharyngoesophageal strictures remains uncertain.

Purpose of the Study:

• To determine the diagnostic accuracy of videofluoroscopy (VF) in detecting pharyngoesophageal strictures.
• To assess VF's effectiveness prior to endoscopic dilatation in HNC survivors with dysphagia.
• To compare VF findings against a gold standard of endoscopic mucosal tear detection.

Main Methods:

• A consecutive series of HNC survivors with dysphagia were evaluated.
• Three experienced, blinded investigators assessed videofluoroscopy (VF) findings for strictures.
• The gold standard for stricture presence was a mucosal tear identified during endoscopic dilatation.

Main Results:

• Observer agreement on VF findings was very poor (kappa = 0.05).
• Videofluoroscopy (VF) demonstrated a sensitivity of 0.76 and specificity of 0.58 for stricture detection.
• Complete agreement among observers occurred in only 10 of 33 patients.

Conclusions:

• Videofluoroscopy (VF) alone is inadequate for accurately detecting pharyngoesophageal strictures in HNC survivors with dysphagia.
• The low inter-observer concordance highlights limitations in VF interpretation for this indication.
• Further investigation into improved diagnostic methods for post-HNC radiotherapy dysphagia is warranted.