Investigation of laryngopharyngeal and oral findings in cancer screening by upper gastrointestinal endoscopy:a large-scale retrospective observational study

Abstract

Background: The role of upper gastrointestinal endoscopy (UGIE) has been recognized in the early detection of laryngopharyngeal and oral cavity cancers; however, the use of UGIE in screening for these cancers has been insufficiently studied.

Subjects and Methods: A total of 51,628 UGIE examinations (n=15,433 patients) for opportunistic screening were performed. We retrospectively investigated the cases of confirmed diagnosis or the subsequent course of 123 cases with pharyngeal and oral findings that required additional investigation by the UGIE examinations.

Results: Additional inspection of suspicious laryngopharyngeal and oral findings was required for 0.24% (123/51,628) cases. In 77 cases, the diagnosis was confirmed by an otolaryngologist. Seven cases had lesion disappearance, which was confirmed by repeat UGIE. In two cases, repeat UGIE performed after five or more years showed no changes in the lesion. The lesions in these nine cases were considered non-malignant. The detection rate and positive predictive value (PPV) for laryngopharyngeal and oral cancers were 0% (0/51,628) and 0% (0/86), respectively. The detection rate and PPV for mild-to-moderate atypical lesions were 0.01% (6/51,628) and 7.8% (6/77), respectively. The most frequent diagnoses were normal, granuloma, papilloma, lymph follicle, and cyst.

Conclusions: UGIE for opportunistic screening without strict guidelines on the consequent observation of the laryngopharyngeal and oral cavity revealed low detection rates of laryngopharyngeal and oral cancers. In addition, utilizing UGIE in this manner led to false positives and overdiagnosis. To minimize these disadvantages, a consensus between laryngopharyngeal and esophageal experts is needed regarding the observation method, proper assessment, and risk stratification of oral and laryngopharyngeal areas using screening UGIE.