Videofluoroscopic swallow examination does not accurately detect cricopharyngeal radiation strictures

Michal M. Szczesniak, Julia MacLean, Joylene O'Hare, Ianessa Humbert, Peter I. Wu, Harry Quon, Peter H. Graham, Ian J. Cook

Research output: Contribution to journalArticlepeer-review

Abstract

Videofluoroscopy is the standard technique to evaluate dysphagia following radiotherapy for head and neck cancer (HNC). The accuracy of radiography in detecting strictures at the pharyngoesophageal junction is unknown. Our aim was to determine the diagnostic accuracy of videofluoroscopy in detecting strictures at the pharyngoesophageal junction prior to endoscopic dilatation in a consecutive series of HNC survivors with dysphagia. Presence of a stricture on videofluoroscopy was determined by 3 experienced blinded investigators and compared against a gold standard, defined as presence of a mucosal tear during endoscopic dilatation. In 10 of 33 patients, there was complete agreement among observers with respect to the presence or absence of a stricture. Overall, the concordance among observers in identification of strictures was very poor, with a kappa of 0.05 (P =.30). The diagnostic sensitivity and specificity of videofluoroscopy in detecting strictures was 0.76 and 0.58, respectively. Videofluoroscopy alone is inadequate to detect strictures in HNC survivors with dysphagia.

Original languageEnglish (US)
Pages (from-to)462-465
Number of pages4
JournalOtolaryngology - Head and Neck Surgery (United States)
Volume155
Issue number3
DOIs
StatePublished - Sep 1 2016

Keywords

  • dysphagia
  • fluoroscopy
  • head and neck cancer
  • pharyngoesophageal junction
  • radiotherapy
  • strictures

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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