Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites

Abstract

BACKGROUND Head and neck squamous cell carcinoma typically is diagnosed at an advanced stage, and the prognosis for patients with this type of malignancy is poor. Detection of these lesions at an earlier stage (e.g., as carcinoma in situ) would be of clear benefit to patients. However, it has been extremely difficult to detect carcinoma in situ at head and neck mucosal sites during routine endoscopy, even after numerous passes of the endoscope through the oral cavity and the pharynx. METHODS The current clinical investigation was performed during routine endoscopic screening or surveillance procedures. The authors used a novel optical technique, known as narrowband imaging (NBI) that allows noninvasive visualization of the microvascular structure of an organ's surface using reflected light. RESULTS Between April 2002 and August 2003, 34 consecutive superficial lesions were found in 18 patients. Multifocal carcinoma was found in 5 patients (28%). The median age of the patients examined was 59.5 years (range, 43–71 years), and 83% of all patients were male. All lesions exhibited a microvascular proliferation pattern on magnified NBI. Thirteen patients with a combined total of 29 lesions underwent endoscopic resection under general anesthesia. The pyriform sinus was the most frequent primary site (66%; 19 of 29 lesions). The median tumor diameter was 20 mm (range, 1.3–40 mm). Twenty‐one lesions (72%) were histologically confirmed to be carcinoma in situ, and the remaining lesions showed evidence of microinvasion (0.05–1 mm) beneath the epithelium. Vascular invasion was observed in only one lesion. The median hospital stay was 10 days (range, 4–18 days). All patients were discharged without severe complications. After a median follow‐up period of 8 months (range, 1–16 months), there were no cases of local disease recurrence. CONCLUSION The authors stress the importance of endoscopic detection of superficial carcinoma at oropharyngeal and hypopharyngeal mucosal sites. NBI is a promising and potentially powerful tool for identifying carcinomas at an earlier stage during routine endoscopic examination. Cancer 2004. © 2004 American Cancer Society.

Laryngeal preneoplastic lesions and cancer: challenging diagnosis. Qualitative literature review and meta-analysis.

“…Nevertheless, NBI is able to better specify their exact extension and show infiltration of neighboring structures. Additionally, NBI might detect second primaries or field cancerization in these patients (138) and it presents a potential advantage in post-treatment surveillance (247)(248)(249). Compared to AFE, NBI endoscopy has the advantage of being able to obtain the same information using both a videoendoscope coupled with a HDTV camera and rigid telescopes (137).…”

The Usefulness of an Intra-Oropharyngeal U-turn Method using Trans-Nasal Endoscopy for Detecting Superficial Squamous Cell Carcinoma of the Base of the Tongue

“…The NBI system (Olympus Medical System Co., Tokyo, Japan) has been already proven to be a useful diagnostic tool for identifying superficial squamous cell carcinoma of the head and neck [4][5][6][19][20][21]. Trans-nasal endoscopy can usually be performed comfortably due to attenuation of the gag reflex [22]; indeed in Japan, trans-nasal endoscopy is a very common procedure and can be performed without sedation.…”

Narrow band imaging in gynecology: A new diagnostic approach with improved visual identification (Review)

“…Neoplastic vessels develop in the surface of tumor lesions, and thus NBI is very useful for observation of microvessels for qualitative diagnosis of tumors and non-tumor lesions (1,5,6,(8)(9)(10). In contrast, evaluation of the microvascular structure with conventional white light endoscopy is difficult.…”