Differences in Clinical Characteristics Between Missed and Detected Laryngopharyngeal Cancers

Laryngopharyngeal cancers are often overlooked during endoscopy because of their anatomical complexity and the gag reflex. However, the characteristics of these cancers remain poorly understood. We studied the differences in clinical characteristics and endoscopic procedures between missed and detected cancers.

Newly diagnosed laryngopharyngeal squamous cell carcinomas identified during esophagogastroduodenoscopy at our hospital between January 2016 and December 2020 were analyzed. A total of 179 lesions were categorized into two groups: missed (n = 74) and detected (n = 105). Missed cancer was defined as a lesion identified within 18 months of preceding esophagogastroduodenoscopy at our hospital, while detected cancer was defined as a lesion not included in the missed group.

The miss rate of laryngopharyngeal cancers on esophagogastroduodenoscopy was 41.3%. Multivariate analysis showed that the non-use rate of pethidine hydrochloride (odds ratio 4.1, 95% confidence interval 2.0-8.6, p < 0.01), ratio of white-light imaging ≥ narrow-band imaging through observation of laryngopharynx (odds ratio 31.8, 95% confidence interval 3.9-258.0, p < 0.01), and number of "comprehensiveness of laryngopharyngeal observation" negatives (odds ratio 2.6, 95% confidence interval 1.3-5.4, p = 0.01) were significantly larger in the missed group. Univariate analysis showed that the number of tumors located on the epiglottis (p = 0.02) was significantly larger in the missed group.

This study highlights the importance of precisely observing the laryngopharynx, facilitated by the use of pethidine hydrochloride and narrow-band imaging. In addition, epiglottic lesions are frequently missed. Comprehensive observation of the laryngopharynx using narrow-band imaging and premedication may reduce the frequency of missed cancers.