Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial

Abstract

Purpose: Most of the esophageal squamous cell carcinomas (ESCCs) and cancers of the head and neck (H&N) region are diagnosed at later stages. To achieve better survival, early detection is necessary. We compared the real-time diagnostic yield of superficial cancer in these regions between conventional white light imaging (WLI) and narrow band imaging (NBI) in high-risk patients.

Patients and methods: In a multicenter, prospective, randomized controlled trial, 320 patients with ESCC were randomly assigned to primary WLI followed by NBI (n = 162) or primary NBI followed by WLI (n = 158) in a back-to-back fashion. The primary aim was to compare the real-time detection rates of superficial cancer in the H&N region and the esophagus between WLI and NBI. The secondary aim was to evaluate the diagnostic accuracy of these techniques.

Results: NBI detected superficial cancer more frequently than did WLI in both the H&N region and the esophagus (100% v 8%, P < .001; 97% v 55%, P < .001, respectively). The sensitivity of NBI for diagnosis of superficial cancer was 100% and 97.2% in the H&N region and the esophagus, respectively. The accuracy of NBI for diagnosis of superficial cancer was 86.7% and 88.9% in these regions, respectively. The sensitivity and accuracy were significantly higher using NBI than WLI in both regions (P < .001 and P = .02 for the H&N region; P < .001 for both measures for the esophagus, respectively).

Conclusion: NBI could be the standard examination for the early detection of superficial cancer in the H&N region and the esophagus.

Fig 1.

CONSORT diagram; overview of the study design. NBI, narrow band imaging.

Fig 2.

Superficial cancer in the head and neck region and esophagus. (A) White light imaging (WLI) shows a small reddish area (arrows) in the posterior wall of the hypopharynx. (B) Magnifying WLI shows a slightly reddish area with tiny microdots. (C) Narrow band imaging (NBI) shows a well-demarcated brownish area (arrows) in the posterior wall of the hypopharynx. (D) Magnifying NBI shows many tiny dots in the brownish area. This lesion was diagnosed histologically as squamous cell carcinoma in situ. (E) WLI shows a slightly reddish and depressed lesion (arrows) in the esophagus, although it is difficult to detect by WLI alone. (F) Magnifying WLI shows a slightly reddish area with an irregular microvascular pattern. (G) NBI shows a well-demarcated brownish area (arrows). (H) Magnifying NBI shows many tiny dots in the brownish area. This lesion was diagnosed histologically as high-grade intraepithelial cancer.