Soft palate leukoplakia as an endoscopic finding associated with esophageal squamous cell carcinoma

We previously reported that specific endoscopic soft palate findings, including a whitish epithelium, were associated with esophageal squamous cell carcinoma (ESCC) history. In the present post hoc analysis of the same cohort, we re-evaluated endoscopic images to identify lesions corresponding to leukoplakia and further characterize their endoscopic features and clinical relevance in relation to ESCC.

This single-center retrospective study included 284 patients who underwent upper gastrointestinal endoscopy at the Osaka International Cancer Institute between January and May 2020. This analysis was based on the identical dataset used in our previous study. Associations between leukoplakia and an ESCC history were analyzed; moreover, the diagnostic performance was compared with conventional risk factors such as alcohol consumption, smoking, and flushing reactions.

Leukoplakia was observed in 15.9% and 3.1% of the patients in the ESCC and non-ESCC groups (P < 0.01), respectively. The interobserver agreement for leukoplakia was substantial (κ = 0.71, 95% confidence interval: 0.56-0.86). Leukoplakia demonstrated a high specificity (96.9%) and a positive likelihood ratio of 5.21 for ESCC history, which were higher than for alcohol consumption and smoking. Leukoplakia was more easily evaluated using narrow band imaging/blue light imaging compared with white light imaging (P = 0.02).

In this post hoc analysis, soft palate leukoplakia was found to be an endoscopic finding associated with ESCC history, supporting the concept of field cancerization of the upper aerodigestive tract. Careful inspection of the soft palate during routine endoscopy may provide additional information for ESCC risk assessment, although prospective validation is warranted.