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Background <p>We previously reported that specific endoscopic soft palate findings, including a whitish epithelium, were associated with esophageal squamous cell carcinoma (ESCC) history. In the present post hoc analysis of the same cohort, we re-evaluated endoscopic images to identify lesions corresponding to leukoplakia and further characterize their endoscopic features and clinical relevance in relation to ESCC.</p> Methods <p>This single-center retrospective study included 284 patients who underwent upper gastrointestinal endoscopy at the Osaka International Cancer Institute between January and May 2020. This analysis was based on the identical dataset used in our previous study. Associations between leukoplakia and an ESCC history were analyzed; moreover, the diagnostic performance was compared with conventional risk factors such as alcohol consumption, smoking, and flushing reactions.</p> Results <p>Leukoplakia was observed in 15.9% and 3.1% of the patients in the ESCC and non-ESCC groups (<i>P</i> &lt; 0.01), respectively. The interobserver agreement for leukoplakia was substantial (κ = 0.71, 95% confidence interval: 0.56–0.86). Leukoplakia demonstrated a high specificity (96.9%) and a positive likelihood ratio of 5.21 for ESCC history, which were higher than for alcohol consumption and smoking. Leukoplakia was more easily evaluated using narrow band imaging/blue light imaging compared with white light imaging (<i>P</i> = 0.02).</p> Conclusions <p>In this post hoc analysis, soft palate leukoplakia was found to be an endoscopic finding associated with ESCC history, supporting the concept of field cancerization of the upper aerodigestive tract. Careful inspection of the soft palate during routine endoscopy may provide additional information for ESCC risk assessment, although prospective validation is warranted.</p>

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Soft palate leukoplakia as an endoscopic finding associated with esophageal squamous cell carcinoma

  • 期刊论文

  • 发表日期：

    2026年6月16日

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  • Kazuki Matsuyama,
  • Ryu Ishihara,
  • Kotaro Waki,
  • Tomoya Ueda,
  • Noriaki Ito,
  • Nobutoshi Tsukuda,
  • Muneshin Morita,
  • Yoshiaki Ando,
  • Yoshimi Tanaka,
  • Minoru Kato,
  • Shunsuke Yoshii,
  • Takashi Kanesaka,
  • Sachiko Yamamoto,
  • Koji Higashino,
  • Noriya Uedo,
  • Tomoki Michida

摘要

Background

We previously reported that specific endoscopic soft palate findings, including a whitish epithelium, were associated with esophageal squamous cell carcinoma (ESCC) history. In the present post hoc analysis of the same cohort, we re-evaluated endoscopic images to identify lesions corresponding to leukoplakia and further characterize their endoscopic features and clinical relevance in relation to ESCC.

Methods

This single-center retrospective study included 284 patients who underwent upper gastrointestinal endoscopy at the Osaka International Cancer Institute between January and May 2020. This analysis was based on the identical dataset used in our previous study. Associations between leukoplakia and an ESCC history were analyzed; moreover, the diagnostic performance was compared with conventional risk factors such as alcohol consumption, smoking, and flushing reactions.

Results

Leukoplakia was observed in 15.9% and 3.1% of the patients in the ESCC and non-ESCC groups (P < 0.01), respectively. The interobserver agreement for leukoplakia was substantial (κ = 0.71, 95% confidence interval: 0.56–0.86). Leukoplakia demonstrated a high specificity (96.9%) and a positive likelihood ratio of 5.21 for ESCC history, which were higher than for alcohol consumption and smoking. Leukoplakia was more easily evaluated using narrow band imaging/blue light imaging compared with white light imaging (P = 0.02).

Conclusions

In this post hoc analysis, soft palate leukoplakia was found to be an endoscopic finding associated with ESCC history, supporting the concept of field cancerization of the upper aerodigestive tract. Careful inspection of the soft palate during routine endoscopy may provide additional information for ESCC risk assessment, although prospective validation is warranted.