Mélissa Gruner1, Angélique Denis2, Claude Masliah3, Morgane Amil4, Elodie Metivier-Cesbron5, Dominique Luet5, Medhi Kaasis6, Emmanuel Coron7, Marc Le Rhun7, Stéphane Lecleire8, Michel Antonietti8, Jean-Louis Legoux9, Laurent Lefrou9, Pascal Renkes10, Anne-Laure Tarreirias11, Philippe Balian11, Philippe Rey12, Bénédicte Prost13, Christophe Cellier14, Gabriel Rahmi14, Elia Samaha14, Serge Fratte15, Béatrice Guerrier16, Verena Landel17, Sandrine Touzet2, Thierry Ponchon1,18,19, Mathieu Pioche1,18,19. 1. Gastroenterology Division, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. 2. Pole de Santé Publique, Statistics and Medical Research Department, Hospices Civils de Lyon, Lyon, France. 3. Gastroenterology Division, Clinique Mutualiste de l'Estuaire, Saint Nazaire, France. 4. Gastroenterology Division, Centre Hospitalier Départemental Les Oudairies, La Roche sur Yon, France. 5. Gastroenterology Division, Centre Hospitalo-Universitaire Larrey, Angers, France. 6. Gastroenterology Division, Centre Hospitalier de Cholet, Cholet, France. 7. Hepatogastroenterology Department, Hotel Dieu, Nantes, France. 8. Gastroenterology Division, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire, Rouen, France. 9. Gastroenterology Division, Hôpital La Source, Centre Hospitalier Régional, Orléans, France. 10. Gastroenterology Division, Hôpital Clinique Claude Bernard, Metz, France. 11. Gastroenterology Division, Hôpital Foch, Suresnes, France. 12. Gastroenterology Division, Hôpital d'Instruction des Armées, Legouest, Metz, France. 13. Gastroenterology Division, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France. 14. Gastroenterology Division, Hôpital Européen Georges Pompidou, Paris, France. 15. Gastroenterology Division, Centre Hospitalier Régional, Belfort, France. 16. Gastroenterology Division, Centre Hospitalier Bourg en Bresse, Bourg en Bresse, France. 17. Direction Recherche Clinique et Innovations, Hospices Civils de Lyon, Lyon, France. 18. Lyon 1 University Claude Bernard, Lyon, France. 19. INSERM U1032, LabTAU, Lyon, France.
Abstract
BACKGROUND: Narrow-band imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect esophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than that of Lugol chromoendoscopy in expert centers, remains to be established in general practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of esophageal SCC and high grade dysplasia (HGD) in current general practice (including tertiary care centers, local hospitals, and private clinics). METHODS: This prospective randomized multicenter trial included consecutive patients with previous or current SCC of the upper aerodigestive tract who were scheduled for gastroscopy. Patients were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI examination was performed after white-light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. RESULTS: 334 patients with history of SCC were included and analyzed (intention-to-treat) from 15 French institutions between March 2011 and December 2015. In per-patient analysis, sensitivity, specificity, positive and negative likelihood values were 100 %, 66.0 %, 21.2 %, and 100 %, respectively, for Lugol chromoendoscopy vs. 100 %, 79.9 %, 37.5 %, and 100 %, respectively, for NBI. Specificity was greater with NBI than with Lugol (P = 0.002). CONCLUSIONS: As previously demonstrated in expert centers, NBI was more specific than Lugol in current gastroenterology practice for the detection of early SCC, but combined approaches with both NBI and Lugol could improve the detection of squamous neoplasia. Thieme. All rights reserved.
BACKGROUND: Narrow-band imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect esophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than that of Lugol chromoendoscopy in expert centers, remains to be established in general practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of esophageal SCC and high grade dysplasia (HGD) in current general practice (including tertiary care centers, local hospitals, and private clinics). METHODS: This prospective randomized multicenter trial included consecutive patients with previous or current SCC of the upper aerodigestive tract who were scheduled for gastroscopy. Patients were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI examination was performed after white-light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. RESULTS: 334 patients with history of SCC were included and analyzed (intention-to-treat) from 15 French institutions between March 2011 and December 2015. In per-patient analysis, sensitivity, specificity, positive and negative likelihood values were 100 %, 66.0 %, 21.2 %, and 100 %, respectively, for Lugol chromoendoscopy vs. 100 %, 79.9 %, 37.5 %, and 100 %, respectively, for NBI. Specificity was greater with NBI than with Lugol (P = 0.002). CONCLUSIONS: As previously demonstrated in expert centers, NBI was more specific than Lugol in current gastroenterology practice for the detection of early SCC, but combined approaches with both NBI and Lugol could improve the detection of squamous neoplasia. Thieme. All rights reserved.
Authors: Laurelle van Tilburg; Steffi E M van de Ven; Manon C W Spaander; Laurens A van Kleef; Robin Cornelissen; Marco J Bruno; Arjun D Koch Journal: J Cancer Res Clin Oncol Date: 2022-06-23 Impact factor: 4.553