Department of Diagnostic Radiology & Organ Imaging, Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR, China.
Radiology. 2011 Feb;258(2):531-7. doi: 10.1148/radiol.10101241. Epub 2010 Dec 3.
To compare the accuracy of magnetic resonance (MR) imaging with that of the current clinical standard of endoscopy and endoscopic biopsy, to determine whether MR imaging depicts subclinical cancers missed at endoscopy and endoscopic biopsy, and to determine whether MR imaging can identify patients without nasopharyngeal carcinoma (NPC) who do not need to undergo invasive sampling biopsy.
The study protocol was approved by the institutional review board; written informed consent was obtained from all patients. Patients suspected of having NPC underwent MR imaging, endoscopy, and endoscopic biopsy. Endoscopic biopsy targeted the suspected tumor or sampled the endoscopically normal nasopharynx. The final diagnosis was based on results of the endoscopic biopsy or on results of a repeat biopsy directed at the lesion detected at MR imaging. The sensitivity and specificity of the three investigations were compared by using the Fisher exact test.
NPC was present in 77 (31%) of 246 patients and absent in 169 (69%) patients. The combined sensitivity, specificity, and accuracy, respectively, were 100%, 93%, and 95% for MR imaging, 90%, 93%, and 92% for endoscopy, and 95%, 100%, and 98% for endoscopic biopsy. Benign disease was mistaken for NPC in 12 (7%) of 169 patients at MR imaging and in 11 (6%) patients at endoscopy. The sensitivity of MR imaging was significantly higher than that of endoscopy (P = .006) and was similar to that of endoscopic biopsy (P = .120). The specificity of MR imaging was similar to that of endoscopy (P = .120) and was significantly lower than that of endoscopic biopsy (P < .001).
MR imaging is an accurate test for the diagnosis of NPC. MR imaging depicts subclinical cancers missed at endoscopy and endoscopic biopsy and helps identify the majority of patients who do not have NPC and who therefore do not need to undergo invasive sampling biopsies.
比较磁共振成像（MR 成像）与当前内镜和内镜活检的临床标准的准确性，以确定 MR 成像是否能描绘出内镜和内镜活检遗漏的亚临床癌症，并确定 MR 成像是否能识别出无需进行侵袭性取样活检的无鼻咽癌（NPC）患者。
本研究方案经机构审查委员会批准；所有患者均签署了书面知情同意书。怀疑患有 NPC 的患者接受了 MR 成像、内镜和内镜活检。内镜活检针对可疑肿瘤或对内镜正常的鼻咽进行取样。最终诊断基于内镜活检的结果或基于对 MR 成像检测到的病变进行重复活检的结果。采用 Fisher 确切检验比较三种检查方法的敏感性和特异性。
246 例患者中，77 例（31%）患有 NPC，169 例（69%）未患有 NPC。MR 成像的联合敏感性、特异性和准确性分别为 100%、93%和 95%，内镜检查分别为 90%、93%和 92%，内镜活检分别为 95%、100%和 98%。12 例（7%）经 MR 成像诊断为 NPC 的患者和 11 例（6%）经内镜检查诊断为 NPC 的患者被误诊为良性疾病。MR 成像的敏感性明显高于内镜检查（P =.006），与内镜活检相似（P =.120）。MR 成像的特异性与内镜检查相似（P =.120），明显低于内镜活检（P <.001）。
MR 成像对于 NPC 的诊断是一种准确的检查方法。MR 成像描绘了内镜和内镜活检遗漏的亚临床癌症，并有助于识别出大多数没有 NPC 且无需进行侵袭性取样活检的患者。
