title: Endoscopic screening for esophageal squamous-cell carcinoma in high-risk patients: a prospective study conducted in 62 French endoscopy centers.
abstract: OBJECTIVE
  The prevalence of esophageal squamous-cell carcinoma in high-risk patients and the advantages of systematic Lugol staining during esophagoscopy have not yet been evaluated in a large prospective study. In this study we aimed to assess the prevalence of this type of tumor in high-risk patients, to examine the role of Lugol staining in endoscopic screening for esophageal squamous-cell carcinoma, and to establish whether it is possible to identify a particularly high-risk group which would benefit from systematic screening.
  
  
  METHODS
  A prospective study was undertaken in 62 endoscopy centers. A total of 1095 patients were enrolled, none of whom had any esophageal symptoms. These patients had presented with either a past history of or a recent head and neck or tracheobronchial squamous-cell carcinoma (group 1), with alcoholic chronic pancreatitis (group 2), with alcoholic cirrhosis (group 3), or were alcohol and tobacco addicts (group 4). The patients underwent a meticulous endoscopic examination of the esophagus, followed by Lugol staining.
  
  
  RESULTS
  The prevalence of esophageal squamous-cell carcinoma was 3.2 %. The group 1 patients showed the highest prevalence of carcinoma (5.3 %) and the highest prevalence of dysplasia (4.5 %). Of the 35 carcinomas detected in the 1095 patients, seven (20 %) were early lesions, and 20 % were only detected after Lugol staining (P = 0.02). High-grade dysplasia was only observed in group 1 patients and two-thirds of these lesions were only diagnosed after Lugol staining. The overall prevalence of low-grade dysplasia was 2.4 %, and 77 % of these were detected only after Lugol staining (P < 0.001).
  
  
  CONCLUSIONS
  Lugol dye staining increases the sensitivity of esophageal endoscopy for the detection of high-grade dysplasia and cancer. The prevalence of dysplasia and cancer reached 9.9 % in group 1, and we therefore believe that an endoscopic screening program could be justified for patients with head and neck or tracheobronchial cancer.
authors.affiliation: Hepatogastroenterology Department, Haut Leveque Hospital, Bordeaux University Hospital, Pessac, France
authors.forename: J
authors.initials: J
authors.lastname: Dubuc
authors.forename: J -L
authors.initials: J-
authors.lastname: Legoux
authors.forename: M
authors.initials: M
authors.lastname: Winnock
authors.forename: J -A
authors.initials: J-
authors.lastname: Seyrig
authors.forename: J -P
authors.initials: J-
authors.lastname: Barbier
authors.forename: T
authors.initials: T
authors.lastname: Barrioz
authors.forename: R
authors.initials: R
authors.lastname: Laugier
authors.forename: G
authors.initials: G
authors.lastname: Boulay
authors.forename: D
authors.initials: D
authors.lastname: Grasset
authors.forename: D
authors.initials: D
authors.lastname: Sautereau
authors.forename: D
authors.initials: D
authors.lastname: Grigoresco
authors.forename: J
authors.initials: J
authors.lastname: Butel
authors.forename: J -Y
authors.initials: J-
authors.lastname: Scoazec
authors.forename: T
authors.initials: T
authors.lastname: Ponchon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D004396:Coloring Agents / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D007454:Iodides / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013194:Staining and Labeling
chemical_list: D004396:Coloring Agents; D007454:Iodides; C010389:Lugol's solution