Original Contribution
The American Journal of Gastroenterology (2005) 100, 275–282; doi:10.1111/j.1572-0241.2005.30189.x
Lugol's Dye Spray Chromoendoscopy Establishes Early Diagnosis of Esophageal Cancer in Patients with Primary Head and Neck Cancer
Claudio L Hashimoto MD1, Kiyoshi Iriya MD1, Elisa R Baba MD1, Tomas Navarro-Rodriguez MD, FACG1, Maria C Zerbini MD1, Jaime N Eisig MD, FACG1, Ricardo Barbuti MD1, Decio Chinzon MD, FACG1 and Joaquim Prado P Moraes-Filho MD, FACP, FACG1
1Department of Gastroenterology; and Department of Pathology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
Correspondence: Claudio L. Hashimoto, MD, Rua Sousa Ramos, 144 apto 151 – Sao Paulo, ZIP: 04120–081 – Brazil
Received 11 October 2004; Revised 0000; Accepted 10 September 2004.
Abstract
OBJECTIVE:
Patients with primary head and neck cancer show a predisposition to develop esophageal cancer. The aim of this study was to investigate in these patients: the prevalence of esophageal cancer comparing the value of chromoendoscopy using Lugol's solution examination to standard endoscopy, in the early diagnosis of esophageal cancer.
METHODS:
Prospective observational study at a state general university hospital in Sao Paulo, Brazil. 326 consecutive adult patients with primary head and neck cancer were evaluated. A standard endoscopy was performed, followed by a 2% lugol's dye spray chromoendoscopy and histopathologic study. The prevalence of esophageal cancer was defined. The results of the two endoscopic methods were compared.
RESULTS:
Twenty-four patients with esophageal cancer and high-grade intraepithelial neoplasia were detected and had a prevalence of 7.36%. Chromoendoscopy and standard endoscopy were equivalent to the diagnosis of advanced and invasive esophageal cancer. However, standard endoscopy diagnosed 55% of high-grade intraepithelial neoplasia, in comparison to chromoendoscopy that detected 100%.
CONCLUSIONS:
Patients with primary head and neck cancer should be considered as high risks for the presence of esophageal cancer. Lugol's dye chromoendoscopy diagnosed high-grade intraepithelial neoplasia, which went unnoticed with standard endoscopy. It permits a more exact detection of lesion boundaries and facilitates a more precise targeting of biopsy fragments.
