Diagnosis method of nasopharyngeal carcinoma

The diagnosis of nasopharyngeal carcinoma should include the following examinations:

(I) Anterior rhinoscopy

After the nasal mucosa is contracted, the posterior nasal cavity and nasopharynx can be viewed through the anterior rhinoscope, and tumors that have invaded or are adjacent to the nostrils can be detected.

(ii) Indirect nasopharyngeal endoscopy

The method is simple and practical. The nasopharyngeal vallecula, the posterior wall of the nasopharyngeal roof and the pharyngeal recesses on both sides should be examined in turn, and the corresponding parts on both sides should be compared and observed. Any asymmetric submucosal protrusions or isolated nodules on both sides should be paid more attention.

Fiberoptic nasopharyngeal endoscopy

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

4. Neck biopsy

For cases that have not been diagnosed by nasopharyngeal biopsy, a neck mass biopsy can be performed. Generally, it can be performed under local anesthesia. During the operation, the first hard lymph node that appears 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.

5. 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. Puncture of nasopharyngeal tumors. 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 10ml 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 2-3 times, and remove the aspirate for cytology or pathology examination.

6. EB virus serological test

At present, 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, while 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 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 carried out, and multiple biopsy examinations should be performed if necessary.

7. Nasopharyngeal lateral radiograph, skull base radiograph and CT examination

Each patient should be routinely examined with lateral nasopharyngeal and skull base photographs. 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 extent of infiltration of the parapharyngeal space. This is extremely important for determining the clinical stage and formulating treatment plans.

8. B-mode ultrasound examination

B-mode ultrasound examination has been widely used in the diagnosis and treatment of nasopharyngeal carcinoma. It is simple, non-invasive and well accepted by patients. In nasopharyngeal carcinoma cases, it is mainly used to examine the liver, neck, retroperitoneum and pelvic lymph nodes to understand whether there is liver metastasis and lymph node density, whether there is cysticity, etc.

9. Magnetic resonance imaging

Since 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.