Comparison of MRI and endoscopy for detection of nasopharyngeal carcinoma among high-risk populations undergoing screening

A prospective population-based screening study by Sun Yat-sen University Cancer Center (Guangzhou, China) compared magnetic resonance imaging (MRI) versus endoscopy for detection of nasopharyngeal carcinoma (NPC) among Epstein-Barr virus (EBC)-seropositive individuals. A total of 814 participants (56% females; median age 53 years; IQR 46-60) underwent both MRI and endoscopy. Suspicious findings from either modality triggered a second endoscopy with biopsy. Thirty-two NPC cases were detected (30 via MRI, 21 via endoscopy) over five years of follow-up. MRI showed a significantly higher overall NPC detection rate (36.9 versus 25.8 per 1000; p=0.007) and early-stage tumor detection (20.9 versus 12.3 per 1000; p=0.020) than endoscopy. MRI als demonstrated a lower false-negative rate (3.0 versus 14.9 per 1000; p=0.024) and higher sensitivity (93.8% versus 65.6%; p=0.007) but lower specificity (84.0% versus 92.8%; p<0.001) and positive predictive value (19.6% versus 27.6%; p=0.019). The authors conclude that these data suggest the potential for extending the rescreening interval for MRI-negative individuals to 5 years.