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DOI: 10.1055/a-2208-3412
Endoscopic submucosal dissection for a small high grade intraepithelial neoplasia in the hypopharynx detected incidentally by artificial intelligence
Authors
Supported by: National Natural Science Foundation of China Grant No: 82170675
Supported by: 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University Grant No: ZYJC21011
Hypopharyngeal carcinoma, a malignant tumor with a poor prognosis, is usually diagnosed at an advanced stage owing to underdiagnosis. Limited knowledge of hypopharyngeal lesions and rapid access to the esophagus during endoscopy might contribute to this delayed diagnosis [1]. Previous studies have shown the potential of artificial intelligence (AI)-based systems for high sensitivity detection of early pharyngeal cancer [2]. Here, we present a case in which a hypopharyngeal precancerous lesion was incidentally detected using AI and successfully treated by endoscopic submucosal dissection (ESD).
A 58-year-old man was referred to our hospital for endoscopic treatment of an esophageal mucosal lesion. He had experienced hoarseness and throat discomfort for 2 years. Enhanced computed tomography of the head and neck showed no obvious thickening or abnormal enhancement in the pharynx, nor any enlarged cervical lymph nodes ([Fig. 1] a). During endoscopic treatment for the esophageal lesion, with the assistance of an AI system, a suspected hypopharyngeal precancerous lesion, approximately 0.7 cm in size, was detected in the corniculate tubercle of the hypopharynx ([Fig. 1] b,c, [Video 1]). Given the previous success of ESD in treating early hypopharyngeal cancer, the patient agreed to undergo the procedure, which was successfully performed [3] [4] ([Fig. 1] d). Histopathology revealed a high grade squamous intraepithelial neoplasia measuring 0.7×0.3 cm ([Fig. 2]).
Subsequent follow-up endoscopy at 1 year showed no residual lesion or recurrence.
The potential for synchronous or metachronous head–neck cancer in patients with esophageal squamous cell carcinoma (ESCC) underscores the significance of careful examination of the pharynx during endoscopy in such patients [5]. Previous AI systems have primarily focused on detecting early hypopharyngeal cancer, leaving uncertainty about their capacity to identify hypopharyngeal precancerous lesions. While our team’s AI system was originally developed for ESCC and precancerous lesions, it has demonstrated efficacy in detecting similar squamous epithelial precancerous lesions in the hypopharynx. Nevertheless, further clinical studies are essential to validate its effectiveness.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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References
- 1 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
- 2 Tamashiro A, Yoshio T, Ishiyama A. et al. Artificial intelligence-based detection of pharyngeal cancer using convolutional neural networks. Dig Endosc 2020; 32: 1057-1065
- 3 Satake H, Yano T, Muto M. et al. Clinical outcome after endoscopic resection for superficial pharyngeal squamous cell carcinoma invading the subepithelial layer. Endoscopy 2015; 47: 11-18
- 4 Shimizu Y, Yamamoto J, Kato M. et al. Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma. Gastrointest Endosc 2006; 64: 255-259 discussion 260–252
- 5 Shimizu Y, Tsukagoshi H, Fujita M. et al. Head and neck cancer arising after endoscopic mucosal resection for squamous cell carcinoma of the esophagus. Endoscopy 2003; 35: 322-326
Correspondence
Publication History
Article published online:
12 December 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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References
- 1 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
- 2 Tamashiro A, Yoshio T, Ishiyama A. et al. Artificial intelligence-based detection of pharyngeal cancer using convolutional neural networks. Dig Endosc 2020; 32: 1057-1065
- 3 Satake H, Yano T, Muto M. et al. Clinical outcome after endoscopic resection for superficial pharyngeal squamous cell carcinoma invading the subepithelial layer. Endoscopy 2015; 47: 11-18
- 4 Shimizu Y, Yamamoto J, Kato M. et al. Endoscopic submucosal dissection for treatment of early stage hypopharyngeal carcinoma. Gastrointest Endosc 2006; 64: 255-259 discussion 260–252
- 5 Shimizu Y, Tsukagoshi H, Fujita M. et al. Head and neck cancer arising after endoscopic mucosal resection for squamous cell carcinoma of the esophagus. Endoscopy 2003; 35: 322-326