Complementary roles of MRI and endoscopic examination in the early detection of nasopharyngeal carcinoma

King, Ann D.; Woo, John K. S.; Ai, Qi Yong H.; Chan, Jimmy W.M.; Lam, W.K. Jacky; Tse, I.O.L.; Bhatia, Kunwar S.; Zee, Benny; Hui, Edwin P.; B.Y., Brigette; Chiu, Rossa W.K.; Hasselt, Andrew C. van; Chan, Anthony Tak Cheung; Lo, Y.M. Dennis; Chan, Ka‐Kui

doi:10.1093/annonc/mdz106

Cited by 54 publications

(46 citation statements)

References 11 publications

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“…3 This figure rises to 17% in asymptomatic patients screened for NPC using persistently elevated plasma Epstein-Barr virus DNA. 4 In both studies, MR imaging detected tumors up to 3 years before they became visible endoscopically. 4,6 MR imaging, therefore, has a complementary role in early NPC detection.…”

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confidence: 93%

“…4 In both studies, MR imaging detected tumors up to 3 years before they became visible endoscopically. 4,6 MR imaging, therefore, has a complementary role in early NPC detection.…”

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confidence: 93%

“…Accordingly, endoscopic tumor detection is challenging at this site, not only for asymptomatic patients in the screening setting but also for symptomatic patients in the clinical setting. Several studies investigating patients with suspected NPC from endemic regions, 3,4 as well as nonendemic regions, 5 have shown that MR imaging can detect NPCs hidden from endoscopic view. In an MR imaging study of predominantly symptomatic patients referred to the outpatient clinic with suspected NPC, we found that MR imaging detects the 10% of tumors that are hidden from endoscopic view.…”

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confidence: 99%

“…We have shown that the standardized MR imaging grading system used at our institution has a high sensitivity for NPC detection, 3,4,7 which includes early-stage tumors hidden on the endoscopic examination that tend to form a focal mass in the roof or pharyngeal recess. 3,4 However, some early-stage cancers confined within the nasopharynx are diffuse rather than focal. In these diffuse early-stage NPCs, the wall thickening is usually greater on one side of the nasopharynx, so discrimination of NPC from benign hyperplasia of the walls and adenoid relies heavily on finding asymmetry on bilateral nasopharyngeal MR imaging evaluations.…”

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confidence: 99%

“…In these diffuse early-stage NPCs, the wall thickening is usually greater on one side of the nasopharynx, so discrimination of NPC from benign hyperplasia of the walls and adenoid relies heavily on finding asymmetry on bilateral nasopharyngeal MR imaging evaluations. 3,4,8,9 Unfortunately, on scrutiny of the images for small early-stage tumors, benign hyperplasia is often slightly asymmetric. This characteristic is challenging in screened subjects with benign lesions and could produce false-positive findings leading to unnecessary alarm and resource usage.…”

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confidence: 99%

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Early Detection of Cancer: Evaluation of MR Imaging Grading Systems in Patients with Suspected Nasopharyngeal Carcinoma

King

Woo²,

Ai³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:We evaluated modifications to our contrast-enhanced MR imaging grading system for symptomatic patients with suspected nasopharyngeal carcinoma, aimed at improving discrimination of early-stage cancer and benign hyperplasia. We evaluated a second non-contrast-enhanced MR imaging grading system for asymptomatic patients from nasopharyngeal carcinoma plasma screening programs. MATERIALS AND METHODS:Dedicated nasopharyngeal MR imaging before (plain scan system) and after intravenous contrast administration (current and modified systems) was reviewed in patients from a nasopharyngeal carcinoma-endemic region, comprising 383 patients with suspected disease without nasopharyngeal carcinoma and 383 patients with nasopharyngeal carcinoma. The modified and plain scan systems refined primary tumor criteria, added a nodal assessment, and expanded the system from 4 to 5 grades. The overall combined sensitivity and specificity of the 3 systems were compared using the extended McNemar test (a x 2 value x 2 ð2Þ . 5.99 indicates significance). RESULTS:The current, modified, and plain scan MR imaging systems yielded sensitivities of 99.74%, 97.91%, and 97.65%, respectively, and specificities of 63.45%, 89.56% and 86.42%, respectively. The modified system yielded significantly better performance than the current (x 2 ð2Þ ¼ 122) and plain scan (x 2 ð2Þ ¼ 6.1) systems. The percentages of patients with nasopharyngeal carcinoma in grades 1-2, grade 3, and grades 4-5 for the modified and plain scan MR imaging systems were 0.42% and 0.44%; 6.31% and 6.96%; and 90.36% and 87.79%, respectively. No additional cancers were detected after contrast administration in cases of a plain scan graded 1-2. CONCLUSIONS:We propose a modified MR imaging grading system that improves diagnostic performance for nasopharyngeal carcinoma detection. Contrast was not valuable for low MR imaging grades, and the plain scan shows potential for use in screening programs. ABBREVIATION: NPC ¼ nasopharyngeal carcinoma

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confidence: 93%

“…4 In both studies, MR imaging detected tumors up to 3 years before they became visible endoscopically. 4,6 MR imaging, therefore, has a complementary role in early NPC detection.…”

mentioning

confidence: 93%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Early Detection of Cancer: Evaluation of MR Imaging Grading Systems in Patients with Suspected Nasopharyngeal Carcinoma

King

Woo²,

Ai³

et al. 2020

AJNR Am J Neuroradiol

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Comparison of new magnetic resonance imaging grading system with conventional endoscopy for the early detection of nasopharyngeal carcinoma

Liu

et al. 2021

Cancer

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Background Although stratifying individuals with respect to nasopharyngeal carcinoma (NPC) risk with Epstein‐Barr virus–based markers is possible, the performance of diagnostic methods for detecting lesions among screen‐positive individuals is poorly understood. Methods The authors prospectively evaluated 882 participants aged 30 to 70 years who were enrolled between October 2014 and November 2018 in an ongoing, population‐based NPC screening program and had an elevated NPC risk. Participants were offered endoscopy and magnetic resonance imaging (MRI), and lesions were identified either by biopsy at a follow‐up endoscopy or further contact and linkage to the local cancer registry through December 31, 2019. The diagnostic performance characteristics of endoscopy and MRI for NPC detection were investigated. Results Eighteen of 28 identified NPC cases were detected by both methods, 1 was detected by endoscopy alone, and 9 were detected by MRI alone. MRI had significantly higher sensitivity than endoscopy for NPC detection overall (96.4% vs 67.9%; Pdifference = .021) and for early‐stage NPC (95.2% vs 57.1%; P = .021). The sensitivity of endoscopy was suggestively lower among participants who had previously been screened in comparison with those undergoing an initial screening (50.0% vs 81.2%; P = .11). The authors observed a higher overall referral rate by MRI versus endoscopy (17.3% vs 9.1%; P < .001). Cases missed by endoscopy had early‐stage disease and were more commonly observed for tumors originating from the pharyngeal recess. Conclusions MRI was more sensitive than endoscopy for NPC detection in the context of population screening but required the referral of a higher proportion of screen‐positive individuals. The sensitivity of endoscopy was particularly low for individuals who had previously been screened.

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Imaging in the Diagnosis of NPC

King,

Zeng,

Wei

2023

Medical Radiology

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Complementary roles of MRI and endoscopic examination in the early detection of nasopharyngeal carcinoma

Cited by 54 publications

References 11 publications

Early Detection of Cancer: Evaluation of MR Imaging Grading Systems in Patients with Suspected Nasopharyngeal Carcinoma

Early Detection of Cancer: Evaluation of MR Imaging Grading Systems in Patients with Suspected Nasopharyngeal Carcinoma

Comparison of new magnetic resonance imaging grading system with conventional endoscopy for the early detection of nasopharyngeal carcinoma

Imaging in the Diagnosis of NPC

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