Lugol's Dye Spray Chromoendoscopy Establishes Early... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: ESOPHAGEAL

Lugol's Dye Spray Chromoendoscopy Establishes Early Diagnosis of Esophageal Cancer in Patients with Primary Head and Neck Cancer

Hashimoto, Claudio L. M.D.; Iriya, Kiyoshi M.D.; Baba, Elisa R. M.D.; Navarro-Rodriguez, Tomas M.D., F.A.C.G.; Zerbini, Maria C. M.D.; Eisig, Jaime N. M.D., F.A.C.G.; Barbuti, Ricardo M.D.; Chinzon, Decio M.D., F.A.C.G.; Moraes-Filho, Joaquim Prado P. M.D., F.A.C.P., F.A.C.G.

Department of Gastroenterology; and Department of Pathology, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil

Reprint requests and correspondence: Claudio L. Hashimoto, M.D., Rua Sousa Ramos, 144 apto 151 – Sao Paulo, ZIP: 04120–081 – Brazil.

Received October 11, 2004; accepted September 10, 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.