What are the examination items for nasopharyngeal carcinoma

What are the examination items for nasopharyngeal carcinoma? Nasopharyngeal carcinoma is a common malignant tumor disease. If it is discovered and treated early, the treatment effect of the disease will be improved. The diagnosis of nasopharyngeal carcinoma must go through a series of examination items. The following will comprehensively introduce these examination items for nasopharyngeal carcinoma, hoping to deepen everyone's understanding of nasopharyngeal carcinoma.

(i) Anterior rhinoscopy: After the nasal mucosa has been retracted, the posterior nasal cavity and nasopharynx can be viewed through the anterior rhinoscopy, and tumors that have invaded or are adjacent to the nostrils can be detected.

(ii) Indirect nasopharyngeal endoscopy is simple and practical. Each wall of the nasopharynx should be examined in turn, with attention paid to the posterior wall of the nasopharyngeal roof and the pharyngeal recesses on both sides. The corresponding parts on both sides should be compared and observed. Any asymmetric submucosal protrusions or isolated nodules on both sides should be paid special attention.

(III) Fiberoptic nasopharyngoscopy During fiberoptic nasopharyngoscopy, 1% ephedrine solution can be used to astringe the nasal mucosa and expand the nasal passages. Then 1% dicaine solution can be used to anesthetize the nasal passages. Then the fiberscope is inserted from the nasal cavity, and the microscope is pushed forward while being observed until it reaches the nasopharyngeal cavity. This method is simple and the mirror is well fixed, but the observation of the posterior nasal cavity and the anterior wall of the roof is not satisfactory.

(IV) Neck biopsy For cases that have not been diagnosed by nasopharyngeal biopsy, neck mass biopsy can be performed. Generally, it can be performed under local anesthesia. During the operation, the earliest solid lymph node should be selected, and the capsule should be removed as a whole. If excisional biopsy is indeed difficult, a wedge-shaped biopsy can be performed at the mass. When removing tissue, a certain depth must be maintained, and squeezing should be avoided. At the end of the operation, the surgical field should not be sutured too tightly or too densely.

For histopathological examination, tissue is bitten from the area where there is a mass or suspected tumor, and the affected lymph nodes should also be removed for pathological diagnosis. The cell bodies of squamous cell carcinoma are large, and the intercellular bridges are visible, so the cell boundaries are clear. The cytoplasm is abundant, eosinophilic, and partially keratinized; the nucleus is obvious, deeply stained, the nuclear atypia is large, and nuclear division is visible. In the center of the cancer nest, some cells are keratinized to form keratinized beads. Squamous cell carcinoma can be divided into three categories: highly differentiated, moderately differentiated, and poorly differentiated according to the degree of keratinization or the number of keratinized beads and the number of intercellular bridges. A special type of nasopharyngeal and oropharyngeal squamous cell carcinoma is lymphoepithelioma, which is poorly differentiated and may even invade the orbit and cause lymph node metastasis before the primary lesion. Sometimes the primary lesion is very small and difficult to locate for biopsy. Most blind biopsies may reveal the primary lesion. One-third of patients have a certain degree of skull base destruction, and most cranial nerves are damaged, with the abducens nerve being damaged first, and then other nerves being paralyzed. Lymphoepithelioma is divided into two subtypes:

(1) Regaud type: The cells are large and poorly differentiated, with round or oval nuclei and vacuolated nuclei. Cancer cells with frequent nuclear divisions are distributed in cords or trabeculae in a rich lymphoid matrix.

(2) Schmincke type: Cancer cells similar to reticular cell degeneration are scattered in the lymphoid stroma in small nests or clusters.

These two types lack keratinization, so diagnosis is difficult. However, electron microscopy shows tension filaments and desmosomes in the cytoplasm, and positive keratin staining can confirm that they come from the epithelium.

(V) Fine needle aspiration This is a simple, safe and efficient method for tumor diagnosis, which has been highly recommended in recent years. For patients suspected of cervical lymph node metastasis, fine needle aspiration can be used to obtain cells first. The specific method is as follows:

1. Nasopharyngeal tumor puncture: Use a No. 7 long needle connected to a syringe. After oropharyngeal anesthesia, insert the needle into the tumor substance under an indirect nasopharyngeal endoscope, draw the syringe to create negative pressure, and move back and forth twice in the tumor. Apply the extract on a slide for cytological examination.

2. Fine needle aspiration of neck mass: Use a No. 7 or No. 9 needle connected to a 10 ml syringe. After local skin disinfection, select the puncture point, insert the needle along the long axis of the tumor, aspirate the syringe and move the needle back and forth in the mass 2 to 3 times, and take out the aspirate for cytology or pathology examination.

(VI) EB virus serological test Currently, the immunoenzymatic method is widely used to detect the titers of IgA/VCA and IgA/EA antibodies of EB virus. The former has a higher sensitivity and a lower accuracy; the latter is just the opposite. Therefore, for those suspected of nasopharyngeal carcinoma, it is advisable to test both antibodies at the same time, which is helpful for early diagnosis. For cases with IgA/VCA titer ≥1:40 and/or IgA/EA titer ≥1:5, even if there is no abnormality in the nasopharynx, exfoliated cells or biopsy should be taken from the site where nasopharyngeal carcinoma is prone to occur. If the diagnosis is still not confirmed for a while, regular follow-up should be performed, and multiple biopsy examinations should be performed if necessary.

(VII) Lateral nasopharyngeal radiographs, skull base radiographs, and CT examinations Every patient should undergo routine lateral nasopharyngeal radiographs and skull base radiographs. If there is suspected invasion of the paranasal sinuses, middle ear, or other parts, corresponding radiographs should be taken at the same time. Units with conditions should perform CT scans to understand the local extension, especially the scope of infiltration of the parapharyngeal space. This is extremely important for determining clinical staging and formulating treatment plans. Lateral nasopharyngeal radiographs show diffuse thickening or local protrusion of the soft tissue on the posterior wall of the top. Skull base radiographs, if the skull base bone is invaded, irregular osteolytic defects with irregular edges or enlarged channels are seen. CT scans have high resolution and can clearly show the mass shadows of soft tissue density and areas of bone destruction, as well as the scope of lesions in the paranasal spaces (Figure 3). Involvement of the orbits, paranasal sinuses, pterygopalatine fossa, and cavernous sinus. CT examinations are of great significance to the design of radiotherapy, selection of surgical methods, and follow-up observations, and should be used as routine examinations.

(VIII) Type B Ultrasound Examination Type B ultrasound examination has been widely used in the diagnosis and treatment of NPC. It is simple, non-invasive and well accepted by patients. In NPC cases, it is mainly used to examine the liver, cervical, retroperitoneal and pelvic lymph nodes to understand the presence of liver metastasis, lymph node density, and cysticity.

(IX) Magnetic resonance imaging examination: Magnetic resonance imaging (MRI) can clearly display various layers of the skull, cerebral sulci, gyri, gray matter, white matter, ventricles, cerebrospinal fluid ducts, blood vessels, etc. The SE method can be used to display T1 and T2 extended high-intensity images to diagnose nasopharyngeal carcinoma, frontal sinus cancer, etc., and to show the relationship between the tumor and surrounding tissues.

The above content about nasopharyngeal carcinoma is the relevant knowledge about nasopharyngeal carcinoma explained to us by experts. We hope it can be helpful to everyone regarding nasopharyngeal carcinoma.