Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2017

Open Access 01-12-2017 | Research article

Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis

Authors: Flavio Hiroshi Ananias Morita, Wanderley Marques Bernardo, Edson Ide, Rodrigo Silva Paula Rocha, Julio Cesar Martins Aquino, Mauricio Kazuyoshi Minata, Kendi Yamazaki, Sergio Barbosa Marques, Paulo Sakai, Eduardo Guimarães Hourneaux de Moura

Published in: BMC Cancer | Issue 1/2017

Login to get access

Abstract

Background

In the early stage esophageal cancer, changes in the mucosa are subtle and pass unnoticed in endoscopic examinations using white light. To increase sensitivity, chromoscopy with Lugol’s solution has been used. Technological advancements have led to the emergence of virtual methods of endoscopic chromoscopy, including narrow band imaging (NBI). NBI enhances the relief of the mucosa and the underlying vascular pattern, providing greater convenience without the risks inherent to the use of vital dye. The purpose of this systematic review and meta-analysis was to evaluate the ability of NBI to diagnose squamous cell carcinoma of the esophagus and to compare it to chromoscopy with Lugol’s solution.

Methods

This systematic review included all studies comparing the diagnostic accuracy of NBI and Lugol chromoendoscopy performed to identify high-grade dysplasia and/or squamous cell carcinoma in the esophagus. In the meta-analysis, we calculated and demonstrated sensitivity, specificity, and positive and negative likelihood values in forest plots. We also determined summary receiver operating characteristic (sROC) curves and estimates of the areas under the curves for both per-patient and per-lesion analysis.

Results

The initial search identified 7079 articles. Of these, 18 studies were included in the systematic review and 12 were used in the meta-analysis, for a total of 1911 patients. In per-patient and per-lesion analysis, the sensitivity, specificity, and positive and negative likelihood values for Lugol chromoendoscopy were 92% and 98, 82 and 37%, 5.42 and 1.4, and 0.13 and 0.39, respectively, and for NBI were 88 and 94%, 88 and 65%, 8.32 and 2.62, and 0.16 and 0.12, respectively. There was a statistically significant difference in only specificity values, in which case NBI was superior to Lugol chromoendoscopy in both analyses. In the per-patient analysis, the area under the sROC curve for Lugol chromoendoscopy was 0.9559. In the case of NBI, this value was 0.9611; in the per-lesion analysis, this number was 0.9685 and 0.9587, respectively.

Conclusions

NBI was adequate in evaluating the esophagus in order to diagnose high-grade dysplasia and squamous cell carcinoma. In the differentiation of those disorders from other esophageal mucosa alterations, the NBI was shown to be superior than Lugol.
Literature
1.
2.
3.
4.
Gibson MK, Tanabe KK, Goldberg RM, Savarese DMF. Epidemiology, pathobiology, and clinical manifestations of esophageal cancer. UpToDate Dec. 2015.
5.
Carvalho R, Areia M, Brito D, Saraiva S, Alves S, Cadime AT. Diagnostic accuracy of lugol chromoendoscopy in the esophagus in patients with head and neck cancer. Rev Esp Enferm Dig. 2013;105(2):79–83.CrossRefPubMed
6.
Hashimoto CL, Iriya K, Baba ER, Navarro-Rodriguez T, Zerbini MC, Eisiq JN, Barbuti R, Chinzon D, Moraes-Filho JP. Lugol’s dye spray chromoendoscopy establishes early diagnosis of esophageal cancer in patients with primary head and neck cancer. Am J Gastroenterol. 2005;100(2):275–82.CrossRefPubMed
7.
Ishihara R, Takeuchi Y, Chatani R, Kidu T, Inoue T, Hanaoka N, Yamamoto S, Higashino K, Uedo N, Iishi H, Tatsuta M, Tomita Y, Ishiguro S. Prospective evaluation of narrow-band imaging endoscopy for screening of esophageal squamous mucosal high-grade neoplasia in experienced and less experienced endoscopists. Dis Esophagus. 2010;23(6):480–6.CrossRefPubMed
8.
Yokoyama A, Ichimasa K, Ishiguro T, Mori Y, Ikeda H, Hayashi T, Minami H, Hayashi S, Watanabe G, Inoue H, Kudo S. Is it proper to use non-magnified narrow-band imaging for esophageal neoplasia screening? Japanese single-center, prospective study. Dig Endosc. 2012;24(6):412–8.CrossRefPubMed
9.
Chai TH, Jin XF, Li SH, Du RL, Zhang J. A tandem trial of HD-NBI versus HD-WL to compare neoplasia miss rates in esophageal squamous cell carcinoma. Hepatogastroenterology. 2014;61(129):120–4.PubMed
10.
Nagai K, Ishihara R, Ishiguro S, Ohta T, Kanzaki H, Yamashina T, Aoi K, Matsuura N, Ito T, Fuji M, Yamamoto S, Hanaoka N, Takeuchi Y, Higashino K, Uedo N, Iishi H, Tatsuta M, Tomita Y, Matsunaga T. Endoscopic optical diagnosis provides high diagnostic accuracy of esophageal squamous cell carcinoma. BMC Gastroenterol. 2014;14:141.CrossRefPubMedPubMedCentral
11.
Minami H, Inoue H, Ikeda H, Satodate H, Hamatani S, Nakao K, Kudo SE. Usefulness of background coloration in detection of esophago-pharyngeal lesions using NBI magnification. Gastroenterol Res Pract. 2012;2012:529782.CrossRefPubMedPubMedCentral
12.
Wang SF, Yang YS, Yuan J, Zhang XL, Lu ZS, Sun G, Linghu EQ, Meng JY. The value of esophageal intrapapillary capillary loop visualized by magnifying narrow-band imaging endoscopy in diagnosing esophageal mucosal pathology. Zhonghua Nei Za Zhi. 2012;51(4):284–8.
13.
Ishihara R, Inoue T, Uedo N, Yamamoto S, Kawada N, Tsujii Y, Kanzaki H, Hanafusa M, Hanaoka N, Takeuchi Y, Higashino K, Iishi H, Tatsuta M, Tomita Y, Ishiguro S. Significance of each narrow-band imaging finding in diagnosing squamous mucosal high-grade neoplasia of the esophagus. J Gastroenterol Hepatol. 2010;25(8):1410–5.CrossRefPubMed
14.
Muto M, Minashi K, Yano T, Saito Y, Oda I, Nonaka S, Omori T, Sugiura H, Goda K, Kaise M, Inoue H, Ishikawa H, Ochiai A, Watanabe H, Tajiri H, Saito D. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol. 2010;28(9):1566–72.CrossRefPubMedPubMedCentral
15.
Lee CT, Chang CY, Lee YC, Tai CM, Wang WL, Tseng PH, Hwang JC, Hwang TZ, Wang CC, Lin JT. Narrow-band imaging with magnifying endoscopy for the screening of esophageal cancer in patients with primary head and neck cancers. Endoscopy. 2010;42(8):613–9.CrossRefPubMed
16.
Yoshida Y, Goda K, Tajiri H, Urashima M, Yoshimura N, Kato T. Assessment of novel endoscopic techniques for visualizing superficial esophageal squamous cell carcinoma: autofluorescence and narrow-band imaging. Dis Esophagus. 2009;22(5):439–46.CrossRefPubMed
17.
Yamasaki Y, Takenaka R, Hori K, Takemoto K, Kawano S, Kawahara Y, Okada H, Fujiki S, Yamamoto K. Tolerability of magnifying narrow band imaging endoscopy for esophageal cancer screening. World J Gastroenterol. 2015;21(9):2793–9.CrossRefPubMedPubMedCentral
18.
Chung CS, Liao LJ, Lo WC, Chou YH, Chang YC, Lin YC, Hsu WF, Shueng PW, Lee TH. Risk factors for second primary neoplasia of esophagus in newly diagnosed head and neck cancer patients: a case-control study. BMC Gastroenterol. 2013;13:154.CrossRefPubMedPubMedCentral
19.
Kim do H, Gong EJ, Jung HY, Lim H, Ahn JY, Choi KS, Lee JH, Choi KD, Song HJ, Lee GH, Kim JH, Roh JL, Nam SY, Kim SY, Baek S. Clinical significance of intensive endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma. Scand J Gastroenterol. 2014;49(12):1486–92.CrossRefPubMed
20.
Gong EJ, Kim DH, Ahn JY, Choi KS, Jung KW, Lee JH, Choi KD, Song HJ, Lee GH, Jung HY, Kim JH, Roh JL, Choi SH, Nam SY, Kim SY. Routine endoscopic screening for synchronous esophageal neoplasm in patients with head and neck squamous cell carcinoma: a prospective study. Dis Esophagus. 2015;49(12):1486–92.
21.
Asada-Hirayama I, Kodashima S, Fujishiro M, Ono S, Niimi K, Mochizuki S, Konno-Shimizu M, Mikami-Matsuda R, Minatsuki C, Nakayama C, Takahashi Y, Yamamichi N, Koike K. Narrow band imaging with magnification can pick up esophageal squamous cell carcinoma more efficiently than lugol chromoendoscopy in patients after chemoradiotherapy. Diagn Ther Endosc. 2013;2013:256439.CrossRefPubMedPubMedCentral
22.
Goda K, Dobashi A, Yoshimura N, Kato M, Aihara H, Sumiyama K, Toyoizumi H, Kato T, Ikegami M, Taijiri H. Narrow-Band Imaging Magnifyin Endoscopy versus Lugol Chromoendoscopy with Pink-Color Sign Assessment in the Diagnosis of Superficial Esophageal Squamous Neoplasms: A Randomised Noninferiority Trial. Gastroenterol Res Pract. 2015;2015:639462.CrossRefPubMedPubMedCentral
23.
Nagami Y, Tominaga K, Machida H, Nakatani M, Kameda N, Sugimori S, Okazaki H, Tanigawa T, Yamagami H, Kudo N, Shiba M, Watanabe K, Watanabe T, Iguchi H, Fujiwara Y, Ohira M, Hirakawa K, Arakawa T. Usefulness of non-magnifying narrow-band imaging in screening of early esophageal squamous cell carcinoma: a prospective comparative study using propensity score matching. Am J Gastroenterol. 2014;109(6):845–54.CrossRefPubMedPubMedCentral
24.
Takahashi M, Shimizu Y, Ono M, Suzuki M, Omori S, Yoshida T, Mori Y, Nakagawa M, Ono S, Nakagawa S, Mabe K, Kato M, Hatanaka K, Asaka M, Sakamoto N. Endoscopic diagnosis of early neoplasia of the esophagus with narrow band imaging: correlations among background coloration and iodine staining findings. J Gastroenterol Hepatol. 2014;29(4):762–8.CrossRefPubMed
25.
Wang CH, Lee YC, Wang CP, Chen CC, Ko JY, Han ML, Chen TC, Lou PJ, Yang TL, Hsiao TY, Wu MS, Wang HP, Tseng PH. Use of transnasal endoscopy for screening of esophageal squamous cell carcinoma in high-risk patients: yield rate, completion rate, and safety. Dig Endosc. 2014;26(1):24–31.CrossRefPubMed
26.
Ide E, Carneiro FOAA, Frazão MSV, Chaves DM, Sallum RAA, de Moura EGH, Sakai P, Maluf-Filho F. Endoscopic Detection of Early Esophageal Squamous Cell Carcinoma in Patients with Achalasia: Narrow-Band Imaging versus Lugol’s Staining. J of Oncology. 2013;2013:736756.CrossRef
27.
Kawai T, Takagi Y, Yamamoto K, Hayama Y, Fukuzawa M, Yagi K, Fukuzawa M, Kataoka M, Kawakami K, Itoi T, Moriyasu F, Matsubabayashi J, Nagao T. Narrow-band imaging on screening of esophageal lesions using an ultrathin transnasal endoscopy. J Gastroenterol Hepatol. 2012;27 Suppl 3:34–9.CrossRefPubMed
28.
Ide E, Maluf-Filho F, Chaves DM, Matuguma SE, Sakai P. Narrow-band imaging without magnification for detectinh early esophageal squamous cell carcinoma. World J Gastroenterol. 2011;17(39):4408–13.CrossRefPubMedPubMedCentral
29.
Lecleire S, Antonietti M, Iwanicki-Caron I, Duclos A, Lemoine F, Pessot FL, Michel P, Ducrotté P, Fiore F. Lugol chromo-endoscpy versus narrow band imaging for endoscopic screening of esophageal squamous-cell carcinoma in patients with a history of cured esophageal cancer: a feasibility study. Dis Esophagus. 2011;24(6):418–22.CrossRefPubMed
30.
Takenaka R, Kawahara Y, Okada H, Hori K, Inoue M, Kawano S, Tanioka D, Tsuzuki T, Uemura M, Ohara N, Tominaga S, Onoda T, Yamamoto K. Narrow-band imaging provides reliable screening for esophageal malignancy in patients with head and neck cancers. Am J Gastroenterol. 2009;104(12):2942–8.CrossRefPubMed
31.
Huang LY, Cui J, Wu CR, Liu YX, Xu N. Narrow-band imaging in the diagnosis of early esophageal cancer and precancerous lesions. Chin Med J (Engl). 2009;122(7):776–80.
32.
Lee YC, Wang CP, Chen CC, Chiu HM, Ko JY, Lou PJ, Yang TL, Huang HY, Wu MS, Lin JT, Hsiu-Hsi Chen T, Wang HP. Transnasal endoscopy with narrow-band imaging and Lugol staining to screen patients with head and neck câncer whose condition limits oral intubation with standard endoscope (with vídeo). Gastrointest Endosc. 2009;69(3 Pt 1):408–17.CrossRefPubMed
33.
Kuraoka K, Hoshino E, Tsuchida T, Fujisaki J, Takahashi H, Fujita R. Early esophageal cancer can be detected by screening endoscopy assisted with narrow-band imaging (NBI). Hepatogastroenterology. 2009;56(89):63–6.PubMed
Metadata
Title
Narrow band imaging versus lugol chromoendoscopy to diagnose squamous cell carcinoma of the esophagus: a systematic review and meta-analysis
Authors
Flavio Hiroshi Ananias Morita
Wanderley Marques Bernardo
Edson Ide
Rodrigo Silva Paula Rocha
Julio Cesar Martins Aquino
Mauricio Kazuyoshi Minata
Kendi Yamazaki
Sergio Barbosa Marques
Paulo Sakai
Eduardo Guimarães Hourneaux de Moura
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2017
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-3011-9

Other articles of this Issue 1/2017

BMC Cancer 1/2017 Go to the issue

Research article

Integrator complex subunit 6 (INTS6) inhibits hepatocellular carcinoma growth by Wnt pathway and serve as a prognostic marker

Research article

New use of low-dose aspirin and risk of colorectal cancer by stage at diagnosis: a nested case–control study in UK general practice

Case report

Extranodal natural killer/T-cell lymphoma in Malawi: a report of three cases

Correction

Correction to: iCanADAPT early protocol: randomised controlled trial (RCT) of clinician supervised transdiagnostic internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety in early stage cancer survivors -vs- treatment as usual

Research article

Rho kinase proteins display aberrant upregulation in vascular tumors and contribute to vascular tumor growth

Research article

MDM2 promoter polymorphism del1518 (rs3730485) and its impact on endometrial and ovarian cancer risk
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits