The characteristics of missed pharyngeal and laryngeal cancers at gastrointestinal endoscopy

Abstract

Objectives Understanding the miss rate and characteristics of missed pharyngeal and laryngeal cancers during upper gastrointestinal endoscopy may aid in reducing the endoscopic miss rate of this cancer type. However, little is known regarding the miss rate and characteristics of such cancers. Therefore, the aim of this study was to investigate the upper gastrointestinal endoscopic miss rate of oro-hypopharyngeal and laryngeal cancers, the characteristics of the missed cancers, and risk factors associated with the missed cancers. Methods Patients who underwent upper gastrointestinal endoscopy and were pathologically diagnosed with oro-hypopharyngeal and laryngeal squamous cell carcinoma from January 2019 to November 2020 at our institution were retrospectively evaluated. Missed cancers were defined as those diagnosed within 15 months after a negative upper gastrointestinal endoscopy. Results A total of 240 lesions were finally included. Eighty-five lesions were classified as missed cancers, and 155 lesions as non-missed cancers. The upper gastrointestinal endoscopic miss rate for oro-hypopharyngeal and laryngeal cancers was 35.4%. Multivariate analysis revealed that a tumor size of <13 mm (odds ratio: 1.96, P=0.026), tumors located on the anterior surface of the epiglottis/valleculae (odds ratio: 2.98, P=0.045) and inside of the pyriform sinus (odds ratio: 2.28, P=0.046) were associated with missed cancers. Conclusions This study revealed a high miss rate of oro-hypopharyngeal and laryngeal cancers during endoscopic observations. High-quality upper gastrointestinal endoscopic observation and awareness of missed cancer may help reduce this rate.

Linked color imaging provides enhanced visibility with a high color difference in upper gastrointestinal neoplasms

“…In logistic regression analysis, the factors associated with neoplasms that were missed under WLI and detected under LCI were found to be low color difference (under WLI) and high color difference (under LCI) regardless of the location, morphology, size, and histopathological type of gastric neoplasms. In previous reports, tumor size, location, and histopathological type were the risk factors for missed pharyngeal, esophageal, and gastric cancers 17–19 . However, our results suggest that the color differences between the neoplasm and the surrounding background mucosa is an important factor in the detection of gastric neoplasms during EGD, rather than the location, morphology, size, and histopathological type.…”

“…In previous reports, tumor size, location, and histopathological type were the risk factors for missed pharyngeal, esophageal, and gastric cancers. [17][18][19] However, our results suggest that the color differences between the neoplasm and the surrounding background mucosa is an important factor in the detection of gastric neoplasms during EGD, rather than the location, morphology, size, and histopathological type.…”

Anatomical classification of pharyngeal and laryngeal endoscopic images using artificial intelligence

“…However, endoscopic observation of the pharynx is prone to blind spots. In a previous study, we reported that 35.4% of pharyngeal and laryngeal cancers were missed during UGE; blind spots neglected during pharyngeal observation are one of the main reasons for false‐negative UGEs, especially when a pharyngeal tumor is located within the pyriform sinus or on the anterior surface of the epiglottis/valleculae 10 . These areas tend to be underexamined, and it is important to remind endoscopists to consciously visualize them during UGEs to avoid missing them.…”

“…We defined missed cancer cases as patients who underwent a UGE in our institute in the 15 months before UGE diagnosis of oro‐hypopharyngeal cancer, and for whom an image of the lesion location was not captured during the first UGE. In some cases, we had previously investigated the characteristics of the missed pharyngeal and laryngeal cancers during UGE; these patients were included in this study; the definition of missed cancers was the same as above 10 . The evaluation was performed using the following method: An endoscopist identified and annotated the correct information on the anatomical locations observed in the pharyngeal and laryngeal endoscopic images when the oro‐hypopharyngeal cancer was missed.…”

“…Key steps to reduce blind spots are a thorough understanding of the anatomical locations to be observed with UGE, determining a standardized procedure process, and performing careful and detailed endoscopic observations. However, UGE is an imaging modality dependent on the operator's skill level, and some endoscopists are inadequately skilled in pharynx examination 10 …”