Comparison of new magnetic resonance imaging grading system with conventional endoscopy for the early detection of nasopharyngeal carcinoma. Issue 18 (7th July 2021)

• Record Type: Journal Article
• Authors: Liu, Zhiwei; Li, Hui; Yu, Kelly J.; Xie, Shang‐Hang; King, Ann D.; Ai, Qi‐Yong H.; Chen, Wen‐Jie; Chen, Xiao‐Xia; Lu, Zi‐Jian; Tang, Lin‐Quang; Wang, Lin; Xie, Chuan‐Miao; Ling, Wei; Lu, Yu‐Qiang; Huang, Qi‐Hong; Coghill, Anna E.; Fakhry, Carole; Pfeiffer, Ruth M.; Zeng, Yi‐Xin; Cao, Su‐Mei; Hildesheim, Allan
• Is Part Of: Cancer. Volume 127:Issue 18(2021)
• Page Start: 3403
• Page End: 3412
• Publication Date: 2021-07-07
• Subjects: cohort study -- early detection -- endoscopy -- magnetic resonance imaging -- nasopharyngeal carcinoma -- screening; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.33552
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : 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%; P difference = .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. Abstract : This prospective study of people at high risk of nasopharyngeal carcinoma (NPC) shows that magnetic resonance imaging (MRI) screening is significantly more sensitive than endoscopy for detecting NPC and early‐stage NPC. There is also a higher overall rate of referral by MRI versus endoscopy, and this leads to a slightly lower positive predictive value for MRI versus endoscopy.