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Gule-Monroe MK, Calle S, Policeni B, Juliano AF, Agarwal M, Chow LQM, Dubey P, Friedman ER, Hagiwara M, Hanrahan KD, Jain V, Rath TJ, Smith RB, Subramaniam RM, Taheri MR, Yom SS, Zander D, Burns J. ACR Appropriateness Criteria® Staging and Post-Therapy Assessment of Head and Neck Cancer. J Am Coll Radiol 2023; 20:S521-S564. [PMID: 38040469 DOI: 10.1016/j.jacr.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
Imaging of head and neck cancer at initial staging and as part of post-treatment surveillance is a key component of patient care as it guides treatment strategy and aids determination of prognosis. Head and neck cancer includes a heterogenous group of malignancies encompassing several anatomic sites and histologies, with squamous cell carcinoma the most common. Together this comprises the seventh most common cancer worldwide. At initial staging comprehensive imaging delineating the anatomic extent of the primary site, while also assessing the nodal involvement of the neck is necessary. The treatment of head and neck cancer often includes a combination of surgery, radiation, and chemotherapy. Post-treatment imaging is tailored for the evaluation of treatment response and early detection of local, locoregional, and distant recurrent tumor. Cross-sectional imaging with CT or MRI is recommended for the detailed anatomic delineation of the primary site. PET/CT provides complementary metabolic information and can map systemic involvement. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Susana Calle
- Research Author, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Q M Chow
- University of Texas at Austin, Dell Medical School, Austin, Texas; American Society of Clinical Oncology
| | | | | | - Mari Hagiwara
- New York University Langone Health, New York, New York
| | | | - Vikas Jain
- MetroHealth Medical Center, Cleveland, Ohio
| | | | - Russell B Smith
- Baptist Medical Center, Jacksonville, Florida; American Academy of Otolaryngology-Head and Neck Surgery
| | - Rathan M Subramaniam
- University of Otago, Dunedin, Otepoti, New Zealand; Commission on Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- George Washington University Hospital, Washington, District of Columbia
| | - Sue S Yom
- University of California, San Francisco, San Francisco, California
| | | | - Judah Burns
- Specialty Chair, Montefiore Medical Center, Bronx, New York
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Gorolay VV, Niles NN, Huo YR, Ahmadi N, Hanneman K, Thompson E, Chan MV. MRI detection of suspected nasopharyngeal carcinoma: a systematic review and meta-analysis. Neuroradiology 2022; 64:1471-1481. [PMID: 35499636 PMCID: PMC9271105 DOI: 10.1007/s00234-022-02941-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/03/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Endoscopic biopsy is recommended for diagnosis of nasopharyngeal carcinoma (NPC). A proportion of lesions are hidden from endoscopic view but detected with magnetic resonance imaging (MRI). This systematic review and meta-analysis investigated the diagnostic performance of MRI for detection of NPC. METHODS An electronic search of twelve databases and registries was performed. Studies were included if they compared the diagnostic accuracy of MRI to a reference standard (histopathology) in patients suspected of having NPC. The primary outcome was accuracy for detection of NPC. Random-effects models were used to pool outcomes for sensitivity, specificity, and positive and negative likelihood ratio (LR). Bias and applicability were assessed using the modified QUADAS-2 tool. RESULTS Nine studies were included involving 1736 patients of whom 337 were diagnosed with NPC. MRI demonstrated a pooled sensitivity of 98.1% (95% CI 95.2-99.3%), specificity of 91.7% (95% CI 88.3-94.2%), negative LR of 0.02 (95% CI 0.01-0.05), and positive LR of 11.9 (95% CI 8.35-16.81) for detection of NPC. Most studies were performed in regions where NPC is endemic, and there was a risk of selection bias due to inclusion of retrospective studies and one case-control study. There was limited reporting of study randomization strategy. CONCLUSION This study demonstrates that MRI has a high pooled sensitivity, specificity, and negative predictive value for detection of NPC. MRI may be useful for lesion detection prior to endoscopic biopsy and aid the decision to avoid biopsy in patients with a low post-test probability of disease.
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Affiliation(s)
- Vineet Vijay Gorolay
- Department of Radiology, Royal Price Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Naomi Natasha Niles
- Department of Ear, Nose and Throat Surgery, Concord Hospital, Concord, NSW, Australia
| | - Ya Ruth Huo
- Department of Radiology, Hospital Road, Concord Repatriation and General Hospital, University of Sydney, Concord, NSW, 2139, Australia
| | - Navid Ahmadi
- Department of Ear, Nose and Throat Surgery, Royal Prince Alfred Hospital, University of New South Wales, Sydney, NSW, Australia
| | - Kate Hanneman
- Department of Medical Imaging, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Thompson
- Department of Radiology, Royal Price Alfred Hospital, University of Sydney, Sydney, NSW, Australia
| | - Michael Vinchill Chan
- Department of Radiology, Hospital Road, Concord Repatriation and General Hospital, University of Sydney, Concord, NSW, 2139, Australia.
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Liu L, Wang H, Yan C, Tao S. An Integrated Analysis of mRNAs and miRNAs Microarray Profiles to Screen miRNA Signatures Involved in Nasopharyngeal Carcinoma. Technol Cancer Res Treat 2020; 19:1533033820956998. [PMID: 32985354 PMCID: PMC7534087 DOI: 10.1177/1533033820956998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE We aim to identify several microRNAs (miRNAs/miRs)-messenger RNAs (mRNAs) biomarkers correlated to nasopharyngeal carcinoma (NPC) based on an integrated analysis of miRNA and mRNAs microarray expression profiles. METHODS The available mRNA and miRNA microarray datasets were retrieved from Gene Expression Omnibus (GEO) database according to pre-determined screening criteria. Differentially expressed miRNA and mRNAs (DEmiRNAs and DEmRNAs) were extracted between NPC and noncancerous nasopharyngeal tissues. The target genes of DEmiRNAs were predicted with miRTarBase followed by the construction of DEmiRNAs-target DEmRNAs network, and functional analyses were performed. The DEmiRNAs expressions were validated and the performance of these DEmiRNAs was assessed by the area under the curve (AUC) values. Finally, the correlations between DEmiRNAs and specific clinical factors were analyzed. RESULTS There were 1140 interaction pairs (including let-7d/f-MYC/HMGA2 and miR-452-ITGA9) in DEmiRNAs-target DEmRNAs network. The GO annotation analysis showed that several genes such as MYC, HMGA2 and ITGA9 primarily participated in cellular process. KEGG analysis showed that these targets were associated with cell cycle and cancer-related pathways. Down-regulated let-7(-d and -f) and up-regulated miR-452 were verified in datasets. The AUC values of these 3 DEmiRNAs (let-7d, let-7-f and miR-452) was 0.803, 0.835 and 0.735, respectively. Besides, miR-452 was significantly related to survival rate of NPC patients. CONCLUSION The findings implied let-7d/f-MYC/HMGA2 and miR-452-ITGA9 might be promising targets for the detection and treatment of NPC.
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Affiliation(s)
- Lei Liu
- Department of Otorhinolaryngology & Head and Neck Surgery, The Third Central Hospital of Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.,Artificial Cell Engineering Technology Research Center, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Hailing Wang
- Department of Diagnostic and Therapeutic Ultrasonography, Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China.,National Clinical Research Center for Cancer, Tianjin, China.,Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Chaohui Yan
- Department of Otorhinolaryngology & Head and Neck Surgery, The Third Central Hospital of Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.,Artificial Cell Engineering Technology Research Center, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Shudong Tao
- Department of Otorhinolaryngology & Head and Neck Surgery, The Third Central Hospital of Tianjin, China.,Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China.,Artificial Cell Engineering Technology Research Center, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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King AD, Woo JKS, Ai QY, Chan JSM, Lam WKJ, Tse IOL, Bhatia KS, Zee BCY, Hui EP, Ma BBY, Chiu RWK, van Hasselt AC, Chan ATC, Lo YMD, Chan KCA. Complementary roles of MRI and endoscopic examination in the early detection of nasopharyngeal carcinoma. Ann Oncol 2020; 30:977-982. [PMID: 30912815 DOI: 10.1093/annonc/mdz106] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early-stage nasopharyngeal carcinoma (NPC) evades detection when the primary tumor is hidden from view on endoscopic examination. Therefore, in a prospective study of subjects being screened for NPC using plasma Epstein-Barr virus (EBV) DNA, we conducted a study to investigate whether magnetic resonance imaging (MRI) could detect endoscopically occult NPC. PATIENTS AND METHODS Participants with persistently positive EBV DNA underwent endoscopic examination and biopsy when suspicious for NPC, followed by MRI blinded to the endoscopic findings. Participants with a negative endoscopic examination and positive MRI were recalled for biopsy or surveillance. Diagnostic performance was assessed by calculating sensitivity, specificity and accuracy, based on the histologic confirmation of NPC in the initial study or in a follow-up period of at least two years. RESULTS Endoscopic examination and MRI were performed on 275 participants, 34 had NPC, 2 had other cancers and 239 without cancer were followed-up for a median of 36 months (24-60 months). Sensitivity, specificity and accuracy were 76.5%, 97.5% and 94.9%, respectively, for endoscopic examination and 91.2%, 97.5% and 96.7%, respectively, for MRI. NPC was detected only by endoscopic examination in 1/34 (2.9%) participants (a participant with stage I disease), and only by MRI in 6/34 (17.6%) participants (stage I = 4, II = 1, III = 1), two of whom had stage I disease and follow-up showing slow growth on MRI but no change on endoscopic examination for 36 months. CONCLUSION MRI has a complementary role to play in NPC detection and can enable the earlier detection of endoscopically occult NPC.
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Affiliation(s)
- A D King
- Departments of Imaging and Interventional Radiology.
| | - J K S Woo
- Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - Q Y Ai
- Departments of Imaging and Interventional Radiology
| | - J S M Chan
- Departments of Imaging and Interventional Radiology
| | - W K J Lam
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - I O L Tse
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K S Bhatia
- Department of Imaging, St Mary's Hospital, Imperial College Healthcare, National Health Service Trust, London, UK
| | - B C Y Zee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - E P Hui
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - B B Y Ma
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - R W K Chiu
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A C van Hasselt
- Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - A T C Chan
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y M D Lo
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K C A Chan
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
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Liang S, Gao Y, Liu Y, Qiu C, Chen Y, Zhu S. Contrast-enhanced Ultrasound in evaluating of angiogenesis and tumor staging of nasopharyngeal carcinoma in nude mice. PLoS One 2019; 14:e0221638. [PMID: 31442259 PMCID: PMC6707564 DOI: 10.1371/journal.pone.0221638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 08/12/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore the use of Contrast-enhanced Ultrasound (CEUS) in evaluating angiogenesis in a xenograft nasopharyngeal carcinoma (NPC) model in nude mice and the evolution of CEUS parameters according to the growth of NPC. METHODS Nude mice were divided into three groups according to experiments conducted at various times from tumor implantation (8 mice/group; group A: 4 weeks from implantation; group B:6 weeks from implantation; group C:8 weeks from implantation). CNE-2 cells were transplanted in 24 nude mice and CEUS evaluations of the tumors were performed at 4, 6 or 8 weeks from implantation. CEUS parametric perfusion images and pathological findings were recorded. R version 3.4.4 software was used to analyze the CEUS parameters and pathological findings. RESULTS One-way anova analysis indicated statistically significant differences among the three groups with the parameters of peak intensity (PI) (p<0.001), area wash in (AWI) (p<0.001), area wash out (AWO) (p<0.001) and tumor volumes (p<0.001).Pearson correlation coefficient analysis indicated that microvessel density (MVD) was correlated with tumor volume (r = 0.644, p = 0.001), PI (r = 0.904, p<0.0001), AWI (r = 0.547, p = 0.008) and AWO (r = 0.744, P<0.0001). Tumor volume was correlated with MVD (r = 0.644, p = 0.001), PI (r = 0.625, p = 0.002), AWI (r = 0.528, p = 0.012) and AWO (r = 0.784, p<0.001). The percentage of necrosis in histological sections was correlated with the percentage of CEUS unperfused area (r = 0.446,p = 0.038). Spearman rank correlation coefficient analysis indicated that vascular endothelial growth factor (VEGF) was correlated with PI (r = 0.462, P = 0.032). Welch t test indicated PI, AWI and AWO parameters were significantly lower than that of kidneys (p<0.001, p = 0.009, p = 0.005). CONCLUSIONS The CEUS parameters PI, AWI and AWO indirectly reflect the MVD and the tumor volume in our model of subcutaneous transplanted NPC in nude mice, providing precious information on angiogenesis and tumor growth. VEGF may play a role in promoting angiogenesis of NPC.
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Affiliation(s)
- ShouJun Liang
- Guangxi Medical University, Nanning, Guangxi, China
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yong Gao
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - YaoLi Liu
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - ChengCheng Qiu
- Guangxi Medical University, Nanning, Guangxi, China
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - YanHao Chen
- Guangxi Medical University, Nanning, Guangxi, China
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - ShangYong Zhu
- Department of Diagnostic Ultrasound, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
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Shilo S, Abu-Ghanem S, Yehuda M, Weinger A, Fliss DM, Abergel A. Nasopharyngeal biopsy in adults presenting with serous otitis media: Cross-sectional study. Head Neck 2018. [DOI: 10.1002/hed.25135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Shahaf Shilo
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Sara Abu-Ghanem
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Moshe Yehuda
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Anat Weinger
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Dan M. Fliss
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Avraham Abergel
- Department of Otolaryngology - Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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7
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King AD, Wong LYS, Law BKH, Bhatia KS, Woo JKS, Ai QY, Tan TY, Goh J, Chuah KL, Mo FKF, Chan KCA, Chan ATC, Vlantis AC. MR Imaging Criteria for the Detection of Nasopharyngeal Carcinoma: Discrimination of Early-Stage Primary Tumors from Benign Hyperplasia. AJNR Am J Neuroradiol 2017; 39:515-523. [PMID: 29284600 DOI: 10.3174/ajnr.a5493] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 10/28/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging can detect nasopharyngeal carcinoma that is hidden from endoscopic view, but for accurate detection carcinoma confined within the nasopharynx (stage T1) must be distinguished from benign hyperplasia of the nasopharynx. This study aimed to document the MR imaging features of stage T1 nasopharyngeal carcinoma and to attempt to identify features distinguishing it from benign hyperplasia. MATERIALS AND METHODS MR images of 189 patients with nasopharyngeal carcinoma confined to the nasopharynx and those of 144 patients with benign hyperplasia were reviewed and compared in this retrospective study. The center, volume, size asymmetry (maximum percentage difference in area between the right and left nasopharyngeal halves), signal intensity asymmetry, deep mucosal white line (greater contrast enhancement along the deep tumor margin), and absence/distortion of the adenoidal septa were evaluated. Differences were assessed with logistic regression and the χ2 test. RESULTS The nasopharyngeal carcinoma center was lateral, central, or diffuse in 134/189 (70.9%), 25/189 (13.2%), and 30/189 (15.9%) cases, respectively. Nasopharyngeal carcinomas involving the walls showed that a deep mucosal white line was present in 180/183 (98.4%), with a focal loss of this line in 153/180 (85%) cases. Adenoidal septa were absent or distorted in 111/111 (100%) nasopharyngeal carcinomas involving the adenoid. Compared with benign hyperplasia, nasopharyngeal carcinoma had a significantly greater volume, size asymmetry, signal asymmetry, focal loss of the deep mucosal white line, and absence/distortion of the adenoidal septa (P < .001). Although size asymmetry was the most accurate criterion (89.5%) for nasopharyngeal carcinoma detection, use of this parameter alone would have missed 11.9% of early-stage T1 nasopharyngeal carcinomas. CONCLUSIONS MR imaging features can help distinguish stage T1 nasopharyngeal carcinoma from benign hyperplasia in most cases.
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Affiliation(s)
- A D King
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - L Y S Wong
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - B K H Law
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - K S Bhatia
- Imaging Department (K.S.B.), St Mary's Hospital, Imperial College Healthcare, National Health Service Trust, London, UK
| | - J K S Woo
- Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
| | - Q-Y Ai
- From the Departments of Imaging and Interventional Radiology (A.D.K., L.Y.S.W., B.K.H.L., Q.-Y.A.)
| | - T Y Tan
- Department of Radiology (T.Y.T.), Changi General Hospital, Singapore
| | - J Goh
- Departments of Diagnostic Radiology (J.G.)
| | - K L Chuah
- Pathology (K.L.C.), Tan Tock Seng Hospital, Singapore
| | - F K F Mo
- Clinical Oncology (F.K.F.M., A.T.C.C.)
| | - K C A Chan
- Department of Chemical Pathology (K.C.A.C.), State Key Laboratory in Oncology in South China, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, S.A.R., China
| | | | - A C Vlantis
- Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
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King AD, Vlantis AC, Yuen TWC, Law BKH, Bhatia KS, Zee BCY, Woo JKS, Chan ATC, Chan KCA, Ahuja AT. Detection of Nasopharyngeal Carcinoma by MR Imaging: Diagnostic Accuracy of MRI Compared with Endoscopy and Endoscopic Biopsy Based on Long-Term Follow-Up. AJNR Am J Neuroradiol 2015; 36:2380-5. [PMID: 26316564 DOI: 10.3174/ajnr.a4456] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/02/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our previous nasopharyngeal carcinoma detection study, comparing MR imaging, endoscopy, and endoscopic biopsy, showed that MR imaging is a highly sensitive test that identifies nasopharyngeal carcinomas missed by endoscopy. However, at the close of that study, patients without biopsy-proved nasopharyngeal carcinoma nevertheless had shown suspicious abnormalities on endoscopy and/or MR imaging. The aim of this study was to determine whether there were any patients with undiagnosed nasopharyngeal carcinoma by obtaining long-term follow-up and to use these data to re-evaluate the diagnostic performance of MR imaging. MATERIALS AND METHODS In the previous study, 246 patients referred to a hospital ear, nose, and throat clinic with suspected nasopharyngeal carcinoma, based on a wide range of clinical indications, had undergone MR imaging, endoscopy, and endoscopic biopsy, and 77 had biopsy-proved nasopharyngeal carcinoma. One hundred twenty-six of 169 patients without biopsy-proved nasopharyngeal carcinoma underwent re-examination of the nasopharynx after a minimum of 3 years, including 17 patients in whom a previous examination (MR imaging = 11; endoscopy = 7) had been positive for nasopharyngeal carcinoma, but the biopsy had been negative for it. Patients with nasopharyngeal carcinoma were identified by biopsy obtained in the previous and this follow-up study; patients without nasopharyngeal carcinoma were identified by the absence of a tumor on re-examination of the nasopharynx. The sensitivity and specificity of the previous investigations were updated and compared by using the Fisher exact test. RESULTS One patient with a previous positive MR imaging finding was subsequently proved to have nasopharyngeal carcinoma. Nasopharyngeal carcinomas were not found in the remaining 125 patients at follow-up, and the previous positive findings for nasopharyngeal carcinoma on MR imaging and endoscopy were attributed to benign lymphoid hyperplasia. The diagnostic performances for the previous MR imaging, endoscopy, and endoscopic biopsy were 100%, 88%, and 94%, respectively, for sensitivity, and 92%, 94%, and 100%, respectively, for specificity; the differences between MR imaging and endoscopy were significant for sensitivity (P = .003) but not specificity (P = .617). CONCLUSIONS MR imaging detected the 12% of nasopharyngeal carcinomas that were endoscopically invisible, including 1 cancer that remained endoscopically occult for several years. Lymphoid hyperplasia reduced the specificity of MR imaging.
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Affiliation(s)
- A D King
- From the Department of Imaging and Interventional Radiology (A.D.K., T.W.C.Y., B.K.H.L., K.S.B., A.T.A.)
| | - A C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery (A.C.V., J.K.S.W.)
| | - T W C Yuen
- From the Department of Imaging and Interventional Radiology (A.D.K., T.W.C.Y., B.K.H.L., K.S.B., A.T.A.)
| | - B K H Law
- From the Department of Imaging and Interventional Radiology (A.D.K., T.W.C.Y., B.K.H.L., K.S.B., A.T.A.)
| | - K S Bhatia
- From the Department of Imaging and Interventional Radiology (A.D.K., T.W.C.Y., B.K.H.L., K.S.B., A.T.A.)
| | - B C Y Zee
- Jockey Club School of Public Health and Primary Care (B.C.Y.Z.)
| | - J K S Woo
- Department of Otorhinolaryngology, Head and Neck Surgery (A.C.V., J.K.S.W.)
| | - A T C Chan
- Departments of Clinical Oncology (A.T.C.C.)
| | - K C A Chan
- Chemical Pathology (K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R., China
| | - A T Ahuja
- From the Department of Imaging and Interventional Radiology (A.D.K., T.W.C.Y., B.K.H.L., K.S.B., A.T.A.)
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