Structured oropharynx, hypopharynx and larynx assessment during routine esophagogastroduodenoscopy improves detection of pre- and early cancerous lesions: a multicenter, comparative study

Abstract

Background and study aims A structured assessment of the oropharynx, hypopharynx and larynx (OHL) may improve the diagnostic yield for the detection of precancerous and early cancerous lesions (PECLs) during routine esophagogastroduodenoscopy (EGD). Thus, we aimed to compare routine EGDs ± structured OHL assessment (SOHLA), including photo documentation with regard to the detection of PECLs.

Patients and methods Consecutive patients with elective EGD were arbitrarily allocated to endoscopy lists with or without SOHLA. All detected OHL abnormalities were assessed by an otolaryngologist-head & neck surgeon (ORL-HNS) and the frequency of PECLS detected during SOHLA vs. standard cohort compared.

Results Data from 1000 EGDs with and 1000 EGDs without SOHLA were analyzed. SOHLA was successful in 93.3 % of patients, with a median assessment time of 45 seconds (interquartile range: 40–50). SOHLA identified 46 potential PECLs, including two benign subepithelial lesions (4.6 %, 95 % CI: 3.4–6.1) while without SOHLA, no malignant and only one benign lesion was found (P < 0.05). ORL-HNS imaging review classified 23 lesions (2.3 %, 95 % CI: 1.5–3.4) as concerning and ORL-HNS clinic assessment was arranged. This identified six PECLs (0.6 %, 95 % CI: 0.2–1.3) including two pharyngeal squamous cell lesions (0.2 %) demonstrating high-grade dysplasia and carcinoma in situ (CIS) and four premalignant glottic lesions (0.4 %) demonstrating low-grade dysplasia and CIS.

Conclusion In the routine setting of a gastrointestinal endoscopy practice precancerous and early cancerous lesions of the oropharynx, hypopharynx, and larynx are rare (< 1 %) but can be detected with a structured assessment of this region during routine upper gastrointestinal endoscopy.

Publication History

Received: 25 July 2020

Accepted: 07 October 2020

Article published online:
25 January 2021

• References

• 1 AIHW. Australian Institute of Health and Welfare. Cancer data in Australia. Canberra: Australian Institute of Health and Welfare; 2019
• 2 Northern Ireland Cancer Registry QsUB, Centre for Public Health. Cancer incidence, prevalence and survival statistics for Northern Ireland: 1993–2017. 2019
• 3 Gatta G, Botta L, Sanchez MJ. et al. Prognoses and improvement for head and neck cancers diagnosed in Europe in early 2000s: The EUROCARE-5 population-based study. Eur J Cancer 2015; 51: 2130-2143
• 4 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70: 7-30
• 5 Chiu PWY, Uedo N, Singh R. et al. An Asian consensus on standards of diagnostic upper endoscopy for neoplasia. Gut 2019; 68: 186-197
• 6 Gogarty DS, Shuman A, OʼSullivan EM. et al. Conceiving a national head and neck cancer screening programme. J Laryngol Otol 2016; 130: 8-14
• 7 Screening PDQ, Prevention Editorial B. Oral Cavity, Pharyngeal, and Laryngeal Cancer Screening (PDQ(R)): Health Professional Version. In: PDQ Cancer Information Summaries. Bethesda (MD): National Cancer Institute (US); 2002
• 8 Shuman AG, McKiernan JT, Thomas D. et al. Outcomes of a head and neck cancer screening clinic. Oral Oncol 2013; 49: 1136-1140
• 9 Howlader NNA, Krapcho M. et al. SEER Cancer Statistics Review, 1975–2016, National Cancer Institute. Bethesda, MD: 2019 https://seer.cancer.gov/csr/1975_2016/
• 10 Vilaseca I, Bernal-Sprekelsen M, Him R. et al. Prognostic factors of quality of life after transoral laser microsurgery for laryngeal cancer. Eur Arch Otorhinolaryngol 2015; 272: 1203-1210
• 11 Amin MBES, Greene F, Byrd DR. et al. AJCC Cancer Staging Manual (8th edition). New York: Springer International Publishing; 2017
• 12 Baliga S, Kabarriti R, Jiang J. et al. Utilization of transoral robotic surgery (TORS) in patients with oropharyngeal squamous cell carcinoma and its impact on survival and use of chemotherapy. Oral Oncol 2018; 86: 75-80
• 13 Mehanna H, Evans M, Beasley M. et al. Oropharyngeal cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; 130: S90-s96
• 14 Pedregal-Mallo D, Sanchez Canteli M, Lopez F. et al. Oncological and functional outcomes of transoral laser surgery for laryngeal carcinoma. Eur Arch Otorhinolaryngol 2018; 275: 2071-2077
• 15 Norfleet RG. “Light up the larynx” during upper gastrointestinal endoscopy. JAMA 1977; 237: 120
• 16 Katsinelos P, Kountouras J, Chatzimavroudis G. et al. Should inspection of the laryngopharyngeal area be part of routine upper gastrointestinal endoscopy? A prospective study. Digest Liver Dis 2009; 41: 283-288
• 17 Kozarek RA. Evaluation of the larynx, hypopharynx, and nasopharynx at the time of diagnostic upper gastrointestinal endoscopy. Gastrointest Endosc 1985; 31: 271-273
• 18 Lehman G, Compton M, Meadows J. et al. Screening examination of the larynx and pharynx during upper gastrointestinal panendoscopy. Gastrointest Endosc 1982; 28: 176-178
• 19 Mullhaupt B, Jenny D, Albert S. et al. Controlled prospective evaluation of the diagnostic yield of a laryngopharyngeal screening examination during upper gastrointestinal endoscopy. Gut 2004; 53: 1232-1234
• 20 Stevens SM, Johnson EA, Pfau PR. et al. Visual evaluation of the larynx and hypopharynx during esophagogastroduodenoscopy: a safety and feasibility study. Surg Endosc 2015; 29: 1209-1215
• 21 Watanabe S, Matsuda K, Arima K. et al. Detection of subclinical disorders of the hypopharynx and larynx by gastrointestinal endoscopy. Endoscopy 1996; 28: 295-298
• 22 Beg S, Ragunath K, Wyman A. et al. Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). Gut 2017; 66: 1886-1899
• 23 Bisschops R, Areia M, Coron E. et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy 2016; 48: 843-864
• 24 Park WG, Shaheen NJ, Cohen J. et al. Quality indicators for EGD. Gastrointest Endosc 2015; 81: 17-30
• 25 Cammarota G, Galli J, Agostino S. et al. Accuracy of laryngeal examination during upper gastrointestinal endoscopy for premalignancy screening: prospective study in patients with and without reflux symptoms. Endoscopy 2006; 38: 376-381
• 26 Nakanishi H, Doyama H, Takemura K. et al. Detection of pharyngeal cancer in the overall population undergoing upper GI endoscopy by using narrow-band imaging: a single-center experience, 2009-2012. Gastrointest Endosc 2014; 79: 558-564
• 27 Emura F, Baron TH, Gralnek IM. The pharynx: examination of an area too often ignored during upper endoscopy. Gastrointest Endosc 2013; 78: 143-149
• 28 OʼSullivan B, Huang SH, Su J. et al. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol 2016; 17: 440-451
• 29 Gillison ML, DʼSouza G, Westra W. et al. Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers. J Natl Can Inst 2008; 100: 407-420
• 30 Boeing H, Dietrich T, Hoffmann K. et al. Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: the prospective EPIC-study. Cancer Cause Control 2006; 17: 957-969
• 31 Slaughter DP, Southwick HW, Smejkal W. Field cancerization in oral stratified squamous epithelium; clinical implications of multicentric origin. Cancer 1953; 6: 963-968
• 32 Muto M, Minashi K, Yano T. et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol 2010; 28: 1566-1572
• 33 Yoshimura N, Goda K, Tajiri H. et al. Diagnostic utility of narrow-band imaging endoscopy for pharyngeal superficial carcinoma. World J Gastroenterol 2011; 17: 4999-5006
• 34 Ishihara R, Takeuchi Y, Chatani R. et al. Prospective evaluation of narrow-band imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia in experienced and less experienced endoscopists. Dis Esoph 2010; 23: 480-486
• 35 Ni XG, Wang GQ. The role of narrow band imaging in head and neck cancers. Curr Oncol Rep 2016; 18: 10