title: Videofluoroscopic Swallow Examination Does Not Accurately Detect Cricopharyngeal Radiation Strictures.
abstract: Videofluoroscopy is the standard technique to evaluate dysphagia following radiotherapy for head and neck cancer (HNC). The accuracy of radiography in detecting strictures at the pharyngoesophageal junction is unknown. Our aim was to determine the diagnostic accuracy of videofluoroscopy in detecting strictures at the pharyngoesophageal junction prior to endoscopic dilatation in a consecutive series of HNC survivors with dysphagia. Presence of a stricture on videofluoroscopy was determined by 3 experienced blinded investigators and compared against a gold standard, defined as presence of a mucosal tear during endoscopic dilatation. In 10 of 33 patients, there was complete agreement among observers with respect to the presence or absence of a stricture. Overall, the concordance among observers in identification of strictures was very poor, with a kappa of 0.05 (P = .30). The diagnostic sensitivity and specificity of videofluoroscopy in detecting strictures was 0.76 and 0.58, respectively. Videofluoroscopy alone is inadequate to detect strictures in HNC survivors with dysphagia.
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia St George Clinical School, University of New South Wales, Sydney, Australia m.szczesniak@unsw.edu.au.
authors.forename: Michal M
authors.initials: MM
authors.lastname: Szczesniak
authors.affiliation: Speech Pathology Department, St George Hospital, Sydney, Australia.
authors.forename: Julia
authors.initials: J
authors.lastname: Maclean
authors.affiliation: Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, Australia.
authors.forename: Joylene
authors.initials: J
authors.lastname: O'Hare
authors.affiliation: Department of Speech, Language, and Hearing Sciences, University of Florida, Gainesville, Florida.
authors.forename: Ianessa
authors.initials: I
authors.lastname: Humbert
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia St George Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Peter I
authors.initials: PI
authors.lastname: Wu
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins Hospital, Baltimore, Maryland, USA Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
authors.affiliation: Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, Australia.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Graham
authors.affiliation: Department of Gastroenterology and Hepatology, St George Hospital, Sydney, Australia St George Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Cook
mesh_terms: D001466:Barium Sulfate; D003251:Constriction, Pathologic; D003287:Contrast Media; D003413:Cricoid Cartilage / Q000528:radiation effects; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D004724:Endoscopy; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D010614:Pharynx / Q000528:radiation effects; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014741:Video Recording
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: dysphagia; fluoroscopy; head and neck cancer; pharyngoesophageal junction; radiotherapy; strictures