The role of cross-sectional imaging in suspected nasopharyngeal carcinoma.
INTRODUCTION
Nasopharyngeal carcinoma is a rare neoplasm in the UK. The current gold standard for detection is endoscopic examination under anaesthesia of the nasopharynx with biopsy. Many clinicians are now advocating cross-sectional imaging as the primary investigation. The objective of this study is to evaluate the role of cross-sectional imaging in detecting nasopharyngeal carcinoma and ultimately to avoid unnecessary biopsy.


MATERIAL AND METHODS
This is a retrospective uncontrolled case series review of patients who were investigated for suspected nasopharyngeal carcinoma between 2009 and 2017 at York Teaching Hospital NHS Foundation Trust. At present, any suspected nasopharyngeal carcinoma requires biopsy. Search terms used were 'endoscopic biopsy of nasopharynx', 'endoscopic examination + biopsy nasopharynx'. The main outcome measures are reported histological and radiological features of malignancy. Only patients who had imaging prior to the biopsy were included.


RESULTS
A total of 144 patients had endoscopic examination under anaesthesia of the nasopharynx with biopsy. Approximately one-third of these patients had cross-sectional imaging before the biopsy. The study revealed that magnetic resonance imaging had 100% sensitivity and 84% specificity; however, the endoscopic examination under anaesthesia and biopsy had only 88% sensitivity. This is due to a negative histological finding despite radiological characteristics of nasopharyngeal carcinoma in some patients. However, the specificity was 100%.


CONCLUSION
The study supports magnetic resonance imaging as the primary investigation in patients with suspected nasopharyngeal carcinoma followed by endoscopic examination under anaesthesia and biopsy in cases with suspicious findings on imaging only.
['Shayah|A|A|', 'Wickstone|L|L|', 'Kershaw|E|E|', 'Agada|F|F|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D004724:Endoscopy D005260:Female D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D008875:Middle Aged D000077274:Nasopharyngeal Carcinoma D009303:Nasopharyngeal Neoplasms D012189:Retrospective Studies D012680:Sensitivity and Specificity D014057:Tomography, X-Ray Computed D055815:Young Adult
Magnetic resonance imaging Nasopharyngeal neoplasms