Background While contrast-enhanced MRI detects early-stage nasopharyngeal carcinoma (NPC) not detected by endoscopic-guided biopsy (EGB), a short contrast-free screening MRI would be desirable for NPC screening programs. This study evaluated a screening MRI in a plasma Epstein–Barr virus (EBV)-DNA NPC screening program. Methods EBV-DNA screen positive patients underwent endoscopy and endoscopy-positive patients underwent EGB. EGB was negative if biopsy was negative or was not performed. Patients also underwent a screening MRI. Diagnostic performance was based on histologic confirmation of NPC in the initial study or during a follow-up period of at least 2 years. Results The study prospectively recruited 354 patients for MRI and endoscopy, 40/354 (11.3%) endoscopy-positive patients underwent EGB. Eighteen had NPC (5.1%) and 336 without NPC (94.9%) were followed-up for a median of 44.8 months. MRI detected additional NPCs in 3/18 (16.7%) endoscopy-negative and 2/18 (11.1%) EGB-negative patients (stage I/II, n = 4; stage III, n = 1). None of the 24 EGB-negative patients who were MRI-negative had NPC. MRI missed NPC in 2/18 (11.1%), one of which was also endoscopy-negative. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI, endoscopy and EGB were 88.9%, 91.1%, 34.8%, 99.4% and 91.0%; 77.8%, 92.3%, 35.0%, 98.7% and 91.5%; 66.7%, 92.3%, 31.6%, 98.1% and 91.0%, respectively. Conclusion A quick contrast-free screening MRI complements endoscopy in NPC screening programs. In EBV-screen-positive patients, MRI enables early detection of NPC that is endoscopically occult or negative on EGB and increases confidence that NPC has not been missed.

中文翻译：

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鼻咽癌的早期发现：短时间无造影剂筛查 MRI

背景 虽然对比增强 MRI 可以检测到内窥镜引导活检 (EGB) 无法检测到的早期鼻咽癌 (NPC)，但简短的无对比筛查 MRI 对于 NPC 筛查项目来说是理想的选择。本研究评估了血浆 Epstein-Barr 病毒 (EBV)-DNA NPC 筛查项目中的筛查 MRI。方法EBV-DNA筛查阳性患者行内镜检查，内镜检查阳性患者行EGB。如果活检呈阴性或未进行活检，则 EGB 呈阴性。患者还接受了核磁共振筛查。诊断性能基于初始研究中或至少 2 年随访期间 NPC 的组织学确认。结果该研究前瞻性招募了354例患者进行MRI和内镜检查，40/354（11.3%）内镜检查阳性患者接受了EGB。18 名患有鼻咽癌 (5.1%) 和 336 名无鼻咽癌 (94.9%) 的患者接受了中位随访 44.8 个月。MRI 在 3/18 (16.7%) 内镜检查阴性和 2/18 (11.1%) EGB 阴性患者中检测到额外的 NPC（I/II 期，n = 4；III 期，n = 1）。24 名 EGB 阴性但 MRI 阴性的患者均未患有 NPC。MRI 漏诊 NPC 的比例为 2/18 (11.1%)，其中 1 例内镜检查结果也呈阴性。MRI、内镜检查和EGB的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为88.9%、91.1%、34.8%、99.4%和91.0%；77.8%、92.3%、35.0%、98.7% 和 91.5%；分别为 66.7%、92.3%、31.6%、98.1% 和 91.0%。结论 快速无造影剂筛查 MRI 可以补充 NPC 筛查项目中的内窥镜检查。在 EBV 筛查呈阳性的患者中，MRI 能够及早发现内窥镜隐匿性或 EGB 阴性的 NPC，并增加未遗漏 NPC 的信心。