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Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial

Published online by Cambridge University Press:  27 March 2008

S M Ragab ,
F A Erfan ,
M A Khalifa ,
E M Korayem  and
H A Tawfik
S M Ragab*
Affiliation:
Department of Otolaryngology & Head and Neck Surgery, Tanta University Hospitals, Tanta, Egypt
F A Erfan
Affiliation:
Department of Otolaryngology & Head and Neck Surgery, Tanta University Hospitals, Tanta, Egypt
M A Khalifa
Affiliation:
Department of Otolaryngology & Head and Neck Surgery, Tanta University Hospitals, Tanta, Egypt
E M Korayem
Affiliation:
Department of Radiodiagnosis, Menoufya Liver Institute, Menoufya, Egypt
H A Tawfik
Affiliation:
Department of Radiotheraphy, Tanta University Hospitals, Tanta, Egypt
*
Address for correspondence: Mr Sameh M Ragab, PO Box 66482, Bayan 43755, Kuwait. Fax: 009655513945 E-mail: [email protected]
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Abstract

Objectives:

To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose.

Methods:

Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy.

Results:

Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001).

Conclusions:

Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.

Keywords

Nasopharyngeal NeoplasmsCarcinomaRadiotherapyBiopsy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 11 , November 2008 , pp. 1230 - 1234
Copyright
Copyright © JLO (1984) Limited 2008

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