Evaluating Synchronous Esophageal Cancer in Head and
Neck Cancer Patients Using Lugol Dye Chromoendoscopy
Supparerk Laohawiriyakamol MD*,
Somkiat Sunpaweravong MD*, Vitoon Leelamanit MD**,
Kowit Pruegsanusak MD**, Wattana Sinkijcharoenchai MD**
Affiliation :
* Department of Surgery, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
** Department of Otolaryngology, Songklanagarind Hospital, Prince of Songkla University, Songkhla, Thailand
Objective : Routine screening for esophageal cancer in head and neck cancer patients in Thailand is controversial, because
of concerns regarding the screening methods and cost effectiveness. Since Lugol dye chromoendoscopy is an effective
technique for early detection of squamous cell carcinoma of the esophagus, the objectives of the present study are to evaluate
the synchronous esophageal cancer in head and neck cancer patients and the effectiveness of Lugol dye chromoendoscopy
for routine screening.
Material and Method: All diagnosed patients with head and neck cancer between September 1, 2009 and June 30, 2011
were enrolled into the study. Both conventional esophagoscopy and Lugol dye chromoendoscopy were done. The incidence
of esophageal cancer was calculated. A diagnostic statistical analysis was done to compare the diagnostic properties between
conventional esophagoscopy and Lugol dye chromoendoscopy. Univariate and multivariate logistic regression analyses
were used to find significant factors associated with esophageal cancer in this study.
Results : Eighty-nine head and neck cancer patients were enrolled in this study. The incidence of esophageal cancer in head
and neck cancer patients was 12.4% (11/89). Conventional esophagoscopy found a highly suspicious malignant lesion in
only six patients, while the Lugol dye chromoendoscopy detected all 11 esophageal cancers. The sensitivity and specificity
for conventional esophagoscopy were 54.5% and 100%, respectively, and for Lugol dye chromoendoscopy were 100% and
70.5%, respectively. The three significant factors that increased the likelihood of synchronous esophageal cancer from
univariate analysis were age less than 50 years, presence of dysphagia, and an unstained Lugol dye area ≥10 mm. However,
these factors were not statistically significant by multivariate analysis.
Conclusion : Lugol dye chromoendoscopy is a promising tool to enhance the diagnosis of esophageal cancer among head
and neck cancer patients.
Keywords : Esophageal cancer, Head and neck cancer, Lugol dye chromoendoscopy
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