Several studies have suggested that a significant minority of esophageal cancers are missed at endoscopy.
Dr Georgina Chadwick and colleagues estimated the proportion of esophageal cancers missed at endoscopy on a national level, and investigated the relationship between miss rates and patient and tumor characteristics.
The research team performed a retrospective, population-based, cohort study identified patients diagnosed with esophageal cancer between 2011 and 2012 in England, using 2 linked databases (National Oesophago-Gastric Cancer Audit and Hospital Episode Statistics).
The team's main outcome was the rate of previous endoscopy within 3–36 months of cancer diagnosis.
This was calculated for the overall cohort and by patient characteristics, including tumor site and disease stage.
A total of 6943 new cases of esophageal cancer were identified, of which 8% had undergone endoscopy in the 3–36 months preceding diagnosis.
Of patients with stage 0/1 cancers, the team found that 34% had undergone endoscopy in the 3–36 months before diagnosis compared with 10% of stage 2 cancers, and 5% of stage 3/4 cancers.
Of patients with stage 0/1 cancers, the team noted that 22% were diagnosed after ≥3 endoscopies in the previous 3 years.
Patients diagnosed with an upper esophageal lesion were more likely to have had an endoscopy in the previous 3–12 months.
The researchers observed that the most common diagnosis at previous endoscopy was an esophageal ulcer.
Dr Chadwick's team concludes, "Esophageal cancer may be missed at endoscopy in up to 8% of patients who are subsequently diagnosed with cancer."
"Endoscopists should make a detailed examination of the whole esophageal mucosa to avoid missing subtle early cancers and lesions in the proximal esophagus."
"Patients with an esophageal cancer may be misdiagnosed as having a benign esophageal ulcer."