Narrow-band imaging versus Lugol chromoendoscopy for esophageal squamous cell cancer screening in normal endoscopic practice: randomized controlled trial

Abstract

Objective: Narrow-Band Imaging (NBI) is as sensitive as Lugol chromoendoscopy to detect oesophageal squamous cell carcinoma (SCC) but its specificity, which appears higher than than that of Lugol chromoendoscopy in expert centres, remains to be established in current practice. This study aimed to prove the superiority of NBI specificity over Lugol chromoendoscopy in the detection of oesophageal SCC and high-grade dysplasia (HGD) in current practice (including tertiary care centres, local hospitals, and private clinics). Trial Design: Prospective randomised multicentre trial including consecutive patients with previous or current SCC of the upper aerodigestive tract addressed for gastroscopy. Patients included were randomly allocated to either the Lugol or NBI group. In the Lugol group, examination with white light and Lugol chromoendoscopy were successively performed. In the NBI group, NBI exam was performed after white light endoscopy. We compared the diagnostic characteristics of NBI and Lugol chromoendoscopy in a per-patient analysis. Results: 334 patients with previous history of SCC were included and analysed in intention-to-tret from 15 French institutions between March 2011 and December 2015. In a per-patient analysis, sensitivity, specificity, positive and negative likelihood values were respectively 100%, 66.0%, 21.2%, and 100% for Lugol chromoendoscopy vs. 100%, 79.9%, 37.5%, and 100% for NBI. NBI specificity was greater than Lugol chromoendoscopy (p=0.0023). Conclusions: As previously demonstrated in expert centres, NBI is more specific than Lugol in current gastroenterology practice for the detection of early SCC but combined approaches with both NBI and lugol could improve the detection of squamous neoplasia.

Endoscopic Surveillance for Metachronous Esophageal Squamous Cell Neoplasms among Head and Neck Cancer Patients

“…The sensitivity, specificity, and positive and negative likelihood values of NBI were 100%, 79.9%, 37.5%, and 100%, respectively. These values for Lugol chromoendoscopy were 100%, 66.0%, 21.2%, and 100%, respectively [18]. The NBI feature was not used as a predictor in our study because there is no standard NBI classification; while NBI is helpful in finding existing dysplastic lesions, it cannot predict the risk of metachronous ESCN.…”

“…IEE with NBI and Lugol chromoendoscopy is a widely used screening tool [17,18]. Based on the systemic review and meta-analysis study, Lugol chromoendoscopy and NBI had high detection rates of ESCN from aerodigestive tract patients (the area under the summary receiver operating characteristic curve(sROC), Lugol: 0.96 vs. NBI: 0.96).…”

“…Lugol chromoendoscopy had similar sensitivity and positive and negative likelihood values, but lower specificity compared with NBI [17]. Gruner et al initiated a prospective randomized trial to compare NBI and Lugol chromoendoscopy in a survey of esophageal neoplasm in 334 patients with aerodigestive tract SCC [18]. The sensitivity, specificity, and positive and negative likelihood values of NBI were 100%, 79.9%, 37.5%, and 100%, respectively.…”

Usefulness of an artificial intelligence system for the detection of esophageal squamous cell carcinoma evaluated with videos simulating overlooking situation

“…Clinical trials are another method by which the AI system's performance could be evaluated. However, ESCC is not a common cancer, and the prevalence of ESCC in prospective studies has been 1.9% (2/105 cases) 19 to 10.8% (36/334 cases) 20 even in high‐risk populations. Evaluating the performance of the AI system with a large number of ESCCs would require a long investigative period and be expensive, in contrast to the current study, in which we directly compared the endoscopists' diagnostic performance with that of the AI system.…”

Current Status of Image-Enhanced Endoscopy for Early Identification of Esophageal Neoplasms

“…The authors concluded that NBI was more specific than LCE in the current gastroenterology practice for the detection of early ESCC as previously demonstrated in expert centers. 54 The education program for non-expert or less experienced endoscopists may prove useful in improving the diagnostic accuracy of NBI during surveillance or screening endoscopy. Recently, NBI with a "dual-focus" mode (DF-NBI) was developed.…”