In vivo diagnosis of persistent and recurrent nasopharyngeal carcinoma by contact endoscopy.
OBJECTIVE
To evaluate the potential use of contact endoscopy for the diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.


METHODS
Prospective study to examine 64 consecutive patients who have been irradiated for nasopharyngeal carcinoma in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany [7215 AA, 0 degrees, and 7215 BA, 30 degrees; 23 cm long. 4 mm in diameter]).


METHODS
The superficial cells of the posterior walls of the nasopharynx were stained with 1% methylene blue and examined with contact rhinoscopes with the patient under local anesthesia at high magnifications (x60 and x150). Biopsy of the areas under examination was performed. The contact endoscopic images were analyzed and correlated with the corresponding histological sections of the biopsy tissues.


RESULTS
Contact endoscopy was performed in 64 patients (54 men; mean age, 42 y) with the use of local anesthesia. Four patterns of contact endoscopic findings were identified: squamous metaplasia (43 cases), postirradiation atypia (10), granulation tissue (6), and malignancy (5). In the last group, the nasopharynx appeared normal in two patients (40%). The findings of contact endoscopy correlated well with the histological findings (kappa reliability coefficient = 0.847; P <.001; diagnostic accuracy, 92.1%). For prediction of persistent and recurrent disease, the sensitivity and specificity of endoscopic findings were both 100%.


CONCLUSIONS
Contact endoscopy is an accurate, reliable office-based procedure that allows for in vivo and in situ diagnosis of persistent and recurrent nasopharyngeal carcinoma in postirradiated patients.
Pak
Martin Wai
MW
Division of Otorhinolaryngology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
To
Ka Fai
KF
Leung
Sing Fai
SF
van Hasselt
Charles Andrew
CA
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000473:pathology*; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011446:Prospective Studies