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


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).


CONCLUSIONS
NBI could be the standard examination for the early detection of superficial cancer in the H&N region and the esophagus.
Muto
Manabu
M
Department of Gastroenterology and Hepatology, Kyoto University, Kyoto, Japan. mmuto@kuhp.kyoto-u.ac.jp
Minashi
Keiko
K
Yano
Tomonori
T
Saito
Yutaka
Y
Oda
Ichiro
I
Nonaka
Satoru
S
Omori
Tai
T
Sugiura
Hitoshi
H
Goda
Kenichi
K
Kaise
Mitsuru
M
Inoue
Haruhiro
H
Ishikawa
Hideki
H
Ochiai
Atsushi
A
Shimoda
Tadakazu
T
Watanabe
Hidenobu
H
Tajiri
Hisao
H
Saito
Daizo
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000175:diagnosis*; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000175:diagnosis; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D055096:Optical Devices; D009959:Oropharyngeal Neoplasms / Q000175:diagnosis; D011230:Precancerous Conditions / Q000175:diagnosis*