ABSTRACT Background and aim: patients with head and neck squamous cell malignancies have a higher risk of oesophageal squamous cell carcinomas. Lugol chromoendoscopy in oesophagus is a simple technique with a high diagnostic yield in premalignant lesions. The objective was to analyze its diagnostic accuracy in dysplasia and car- cinoma of the oesophagus in high-risk patients. Methods: prospective study from April/2008 to January/2012 using lugol chromoendoscopy with biopsies of suspicious lugol void- ing areas ≥ 5 mm. Patients with head and neck malignancies were included, except the ones with iodine allergy, oesophageal varices and contra-indications to standard endoscopy. The reference method was histopathology. Results: 89 patients were enrolled (mean age 62.8 ± 13.3 years, 87 % men). Primary tumour was located in oropharynx in 37 (41.6 %), in oral cavity in 29 (32.6 %) and in the larynx in 23 (25.8 %) cases. 40.4 % patients had previous treatments and 87 % reported alcohol or tobacco addition. All exams performed without anaesthesia or complications. Nine suspicious lugol voiding areas were observed and biopsied. Histopathological analysis revealed high-grade dysplasia in 2 (2.2 %) and inflammation or normal findings in the others. The sensitivity and specificity for detecting high-grade dysplasia were 100 % and 92 % (95 % CI: 87-97), respectively. Diagnostic accuracy of the test was 92 % (95 % CI: 86-98). Conclusion: lugol staining of the oesophagus during endoscopy seems to be a feasible, safe and justified procedure in high-risk pop- ulation as it enhances the detection of premalignant lesions. Key words: Oesophageal cancer. Squamous cell carcinoma. Lugol solution. Gastrointestinal Endoscopy. Chromoendoscopy. INTRODUCTION Oesophageal cancer is the eighth most common cancer worldwide and the sixth more common cause of death from cancer (1,2). Squamous cell carcinoma is still the most fre- quent type, but the incidence of adenocarcinoma is rising in developed countries, becoming the most frequent type in these regions (3,4). Important risk factors for oesophageal squamous cell car- cinoma (OSCC) includes alcohol and tobacco addiction (1). Others less frequent risk factors are achalasia, caustic injury, previous radiotherapy for breast cancer, thylosis, ingestion of a hot beverage called maté (particularly in South America) and exposure to polycyclic aromatic hydrocarbons (5). The risk of OSCC is also increased in patients with head and neck squamous cell carcinoma (HNSCC), and the inci- dence in this set varies from 1-17 % (6,7). The presence of multiple cancers is a phenomenon well described and a con- sequence of a theory called “field cancerization”, where repeated exposure to carcinogens leads to accumulation of genetic alterations resulting in the development of indepen- dent cancers (8). This association is related to a poorer dis- ease control and survival rates of both tumours (9). The prognosis of the disease is poor, with a low 5-year survival rate, mainly because the majority is diagnosed at advanced stages. The early detection of precursor lesions can improve the prognosis of these tumours. Lugol chromoendoscopy is a complementary method to standard endoscopy that can enhance the diagnosis of OSCC at earlier stages of dysplasia and non-invasive can- cer. It can be particularly important in screening high-risk groups of patients and in follow-up after OSCC treatment (6,9-12). It can be used also to delineate lesions prior to endoscopic mucosal resection (EMR) and to detect recur- rences at the EMR scar. Normal oesophageal mucosa has glycogen that reacts with lugol iodine solution and forms a brown-green colour. Diagnostic accuracy of lugol chromoendoscopy in the oesophagus in patients with head and neck cancer Rita Carvalho, Miguel Areia, Daniel Brito, Sandra Saraiva, Susana Alves and Ana Teresa Cadime Gastroenterology Unit. Coimbra Portuguese Institute of Oncology. Portugal 1130-0108/2013/105/2/79-83 REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS Copyright © 2013 ARÁN EDICIONES, S. L. REV ESP ENFERM DIG (Madrid) Vol. 105. N.° 2, pp. 79-83, 2013 Received: 13-09-2012 Accepted: 22-02-2013 Correspondence: Rita Carvalho. Gastroenterology Unit. Coimbra Portuguese Institute of Oncology. Avenida Bissaya Barreto, 98, Apartado 2005. 3001- 651 Coimbra, Portugal e-mail: ritamscarvalho@hotmail.com ORIGINAL PAPERS Carvalho R, Areia M, Brito D, Saraiva S, Alves S, Cadime AT. Diagnostic accuracy of lugol chromoendoscopy in the oesophagus in patients with head and neck cancer. Rev Esp Enferm Dig 2013;105:79-83.