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Superiority of NBI endoscopy to PET/CT scan in detecting esophageal cancer among head and neck cancer patients: a retrospective cohort analysis

  • Su, Hsuan-An1
  • Hsiao, Shun-Wen2
  • Hsu, Yu-Chun2
  • Wang, Lien-Yen3
  • Yen, Hsu-Heng2, 4, 5
  • 1 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan , Kaohsiung (Taiwan)
  • 2 Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, Taiwan , Changhua (Taiwan)
  • 3 Changhua Christian Hospital, Changhua, Taiwan , Changhua (Taiwan)
  • 4 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan , Taichung (Taiwan)
  • 5 General Education Center, Chienkuo Technology University, Changhua, Taiwan , Changhua (Taiwan)
Published Article
BMC Cancer
Springer (Biomed Central Ltd.)
Publication Date
Jan 29, 2020
DOI: 10.1186/s12885-020-6558-4
Springer Nature


BackgroundSecond primary cancer of the esophagus is frequent in head and neck patients, especially in high-risk populations, and has a great impact on the prognosis. Although Positron emission tomography (PET)/computed tomography (CT) scan is commonly conducted in head and neck patients, its ability to detect early esophageal cancer is limited. Narrow-band imaging endoscopy is an accurate and convenient technique for esophageal examination. We aimed to compare PET/CT scan and narrow-band imaging endoscopy for the detection of esophageal cancer in head and neck cancer patients.MethodsFrom November 2015 to November 2018, all head and neck cancer patients who underwent both PET/CT scan and narrow-band imaging endoscopy at Changhua Christian Hospital were retrospectively enrolled. Descriptive statistics, receiver operating characteristic curve analysis, logistic regression analysis, independent Student’s t-test, and Kaplan–Meier survival analysis were conducted with MedCalc Statistical Software.ResultsA total of 147 subjects were included in the analysis; suspicious esophageal lesions were identified by PET/CT scan in 8 (5.44%) and by narrow-band imaging in 35 (23.81%). The final pathologic diagnoses were esophageal squamous cell carcinoma in 10 and high-grade dysplasia in 5. The respective sensitivity, specificity, and area under the curve for detecting suspicious esophageal lesions were 33.33, 97.73%, and 0.655 for PET/CT scan, and 100.0, 84.85%, and 0.924 for narrow-band imaging endoscopy. Hypopharyngeal or laryngeal location of the primary head and neck cancer was the only risk factor for developing second primary esophageal cancer.ConclusionsPET/CT scan was inferior to narrow-band imaging endoscopy in detecting second primary esophageal cancer in head and neck cancer patients. In addition to PET/CT scan, narrow-band imaging endoscopy should be considered in head and neck patients at high risk for developing second primary esophageal cancer.

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