title: Diagnostic accuracy of probe-based confocal laser endomicroscopy in Lugol-unstained esophageal superficial lesions of patients with head and neck cancer.
abstract: OBJECTIVE
  Surveillance programs of patients with head and neck cancer (HNC) detect synchronous or metachronous esophageal squamous cell carcinoma (ESCC) in up to 15% of patients. Noninvasive, probe-based confocal laser endomicroscopy (pCLE) technique may improve the diagnosis allowing acquisition of high-resolution in vivo images at the cellular and microvascular levels. The aim of this study was to evaluate the accuracy of pCLE for the differential diagnosis of nonneoplastic and neoplastic Lugol-unstained esophageal lesions in patients with HNC.
  
  
  METHODS
  Twenty-seven patients with HNC who exhibited Lugol-unstained esophageal lesions at surveillance endoscopy were prospectively included for pCLE. Diagnostic pCLE was followed by subsequent biopsies or endoscopic resection of suspected lesions. A senior pathologist was blinded to the pCLE results.
  
  
  RESULTS
  Patients mean age was 59 years (SD = 8.8) and 70.4% were men. All patients were smokers, and 22 patients (81.5%) had a history of alcohol consumption. The locations of HNC were oral cavity (n = 13), larynx (n = 10), and pharynx (n = 4). Thirty-seven lesions in 27 patients were studied. The final diagnoses were ESCC in 17 patients and benign lesions in 20 patients. Sensitivity, specificity, and accuracy of pCLE for the histologic diagnosis of ESCC in patients with HNC were 94.1%, 90.0%, and 91.9%, respectively.
  
  
  CONCLUSIONS
  First, pCLE is highly accurate for real-time histology of Lugol-unstained esophageal lesions in patients with HNC. Second, pCLE may alter the management of patients under surveillance for ESCC, guiding biopsies and endoscopic resection, avoiding further diagnostic workup or therapy of benign lesions.
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Adriana Vaz
authors.initials: AV
authors.lastname: Safatle-Ribeiro
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Elisa Ryoka
authors.initials: ER
authors.lastname: Baba
authors.affiliation: Department of Pathology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Sheila Friedrich
authors.initials: SF
authors.lastname: Faraj
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Juliana Trazzi
authors.initials: JT
authors.lastname: Rios
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Marcelo Simas
authors.initials: MS
authors.lastname: de Lima
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Bruno Costa
authors.initials: BC
authors.lastname: Martins
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Sebastian Naschold
authors.initials: SN
authors.lastname: Geiger
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Caterina
authors.initials: C
authors.lastname: Pennacchi
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Carla
authors.initials: C
authors.lastname: Gusman
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Fábio Shiguehissa
authors.initials: FS
authors.lastname: Kawaguti
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Ricardo Sato
authors.initials: RS
authors.lastname: Uemura
authors.affiliation: Department of Pathology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Evandro Sobroza
authors.initials: ES
authors.lastname: de Melo
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Ulysses
authors.initials: U
authors.lastname: Ribeiro
authors.affiliation: Department of Gastroenterology, University of São Paulo Medical School, São Paulo Cancer Institute, ICESP-HCFMUSP, São Paulo, Brazil.
authors.forename: Fauze
authors.initials: F
authors.lastname: Maluf-Filho
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000473:pathology; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D000077277:Esophageal Squamous Cell Carcinoma; D004945:Esophagoscopy; D005260:Female; D006258:Head and Neck Neoplasms; D006801:Humans; D000069416:Intravital Microscopy; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000473:pathology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D000077195:Squamous Cell Carcinoma of Head and Neck