A Five-Parameter Logistic Model to Predict the Possibility of Misdiagnosis for Improving the Specificity of Lugol Chromoendoscopy in the Diagnosis of Esophageal Neoplastic Lesions

Zijun Guo; Lingjun Meng; Shuxin Tian; Lan Chen; Huiying Shi; Mengke Fan; Rong Lin

doi:10.3389/fonc.2021.763375

A Five-Parameter Logistic Model to Predict the Possibility of Misdiagnosis for Improving the Specificity of Lugol Chromoendoscopy in the Diagnosis of Esophageal Neoplastic Lesions

Front Oncol. 2022 Jan 3:11:763375. doi: 10.3389/fonc.2021.763375. eCollection 2021.

Authors

Zijun Guo¹, Lingjun Meng¹, Shuxin Tian^{1

2}, Lan Chen³, Huiying Shi¹, Mengke Fan¹, Rong Lin¹

Affiliations

¹ Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Gastroenterology, The First Affiliated Hospital, Shihezi University, Shihezi, China.
³ Department of Gastroenterology, The Sixth Hospital, Jianghan University, Wuhan, China.

Abstract

Background: Lugol chromoendoscopy (LCE) is a technique that is inexpensive and convenient for screening esophageal neoplastic lesions. However, the specificity of LCE is limited. The purpose of this study was to determine the risk characteristics of lesions related to false-positive results for LCE.

Methods: In this retrospective study, 871 lesions in 773 patients scheduled for LCE in Wuhan Union Hospital and First Affiliated Hospital of Shihezi University between April 2013 and October 2018 were enrolled. The 871 lesions were used to determine the diagnostic performance of LCE for detecting esophageal neoplastic lesions and were divided into an LCE-positive group (627 lesions) and an LCE-negative group (244 lesions). Six hundred and twenty-seven unstained/understained lesions from 563 patients were used to determine the significant risk factors for misdiagnosis of neoplasms by LCE. Among them, 358 lesions and 269 lesions were classified into the misdiagnosed group and correctly diagnosed group, respectively. A multivariate logistic regression analysis was conducted for suspected esophageal neoplastic lesions during the LCE examination.

Results: The sensitivity, specificity, and overall accuracy for LCE were 100%, 40.5%, and 58.9%, respectively. Among 13 characteristics of lesions, lesions with branching vascular network (OR 4.53, 95% CI 2.23-9.21, p < 0.001), smooth lesions (OR 2.40, 95% CI 1.38-4.18, p = 0.002) under white light endoscopy (WLE), lesions with a size < 5 mm (OR 3.06, 95% CI 1.38-6.78, p = 0.006), ill-demarcated lesions (OR 7.83, 95% CI 4.59-13.37, p < 0.001), and pink color sign (PCS)-negative (OR 4.04, 95% CI 2.38-6.84, p < 0.001) lesions after reaction with iodine solution were independent risk factors for misdiagnosis as neoplastic lesions by LCE.

Conclusion: LCE has a high sensitivity but limited specificity for screening esophageal neoplastic lesions. For unstained or understained lesions, branching vascular network or smooth appearance under WLE, a size < 5 mm in diameter, ill-demarcated, or PCS-negative lesions after staining are related to the misdiagnosis of esophageal neoplastic lesions by LCE based on logistic regression. The multivariate logistic model may be used to predict the possibility of misdiagnosis and help improve the specificity of LCE in diagnosing esophageal neoplastic lesions.

Keywords: Lugol chromoendoscopy; esophageal neoplasia; esophageal squamous cell carcinoma; misdiagnosis; risk factors.