TOPLINE:

MRI showed more than 90% sensitivity in detecting nasopharyngeal carcinoma (NPC), surpassing endoscopy’s detection rate of 65.6% over a 5-year period. MRI particularly excelled in identifying early-stage tumors, with a detection rate of 20.9 vs 12.3 per 1000 for MRI vs endoscopy.

METHODOLOGY:

• While nasopharyngeal endoscopy with biopsy remains the diagnostic reference standard for Epstein-Barr virus (EBV)-positive individuals, its sensitivity for detecting early-stage NPC is limited by challenges in identifying small or submucosal lesions. Previous studies demonstrated that MRI detects 17%-34% more NPC cases among asymptomatic EBV-positive individuals and 47% more stage I/II NPC cases than endoscopy during initial screening.
• A prospective population-based screening study enrolled 814 EBV-seropositive individuals aged 30-69 years in Southern China from October 2014 to November 2018.
• Participants underwent both nasopharyngeal endoscopy and MRI examinations, with suspicious findings from either modality triggering a second endoscopy with biopsy.
• Follow-up for cancer diagnoses continued through October 2023, utilizing multiple methods including telephone interviews, home visits, and linkage to local cancer registries.
• Primary endpoints included the 5-year NPC detection rate overall and by stage, false-negative rate, while secondary endpoints encompassed sensitivity, specificity, positive predictive value, and referral rate.

TAKEAWAY:

• MRI demonstrated significantly higher overall NPC detection rate than endoscopy (36.9 per 1000; 95% CI, 25.9-52.1 vs 25.8 per 1000; 95% CI, 16.9-39.1; P = .007), with notably better early-stage tumor detection (20.9 per 1000; 95% CI, 13.1-33.2 vs 12.3 per 1000; 95% CI, 6.7-22.5; P = .020).
• The false-negative rate was significantly lower for MRI than endoscopy (3.0 per 1000; 95% CI, 0.8-11.0 vs 14.9 per 1000; 95% CI, 8.4-26.5; P = .024), with MRI showing higher sensitivity (93.8% vs 65.6%; P = .007).
• Compared with endoscopy, MRI exhibited lower specificity (84.0% vs 92.8%; P < .001) and positive predictive value (19.6% vs 27.6%; P = .019).
• The modified MRI five-grade system improved specificity to 90.2% while maintaining comparable detection rates to the four-grade system (35.6 vs 36.9 per 1000; P = .56).

IN PRACTICE:

“Single MRI demonstrated superior NPC detection vs endoscopy, particularly for early-stage tumors, in high-risk populations during a 5-year period, which suggests the potential for extending the rescreening interval to 5 years for MRI-negative individuals. For MRI-positive individuals with negative biopsies, close surveillance by EBV serological testing and endoscopy for 3 years is recommended,” wrote the authors of the study.

SOURCE:

The study was led by Hang-Ning Zhou, MS, Sun Yat-Sen University Cancer Center in Guangzhou, China. It was published online in Cancer.

LIMITATIONS:

According to the authors, the single-round MRI design limited evaluation of longitudinal tumor progression patterns, though the comprehensive follow-up strategy helped minimize detection bias. Additionally, approximately 25% of EBV-positive individuals declined participation, potentially affecting study outcomes, although these individuals showed comparable NPC incidence rates to study participants. The authors also note that while the study demonstrates improved early detection, mortality outcomes require validation through large-scale randomized trials.

DISCLOSURES:

The study received support from the Noncommunicable Chronic Diseases-National Science and Technology Major Project, National Natural Science Foundation of China, Planned Science and Technology Project of Guangdong Province, Guangdong Medical Research Foundation Projects, and National Cancer Institute. Zhiwei Liu, PhD, disclosed employment with Merck & Co, Inc. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.