Five‐year comparison of magnetic resonance imaging and endoscopy for nasopharyngeal carcinoma detection among high‐risk populations undergoing screening

BACKGROUND: The long-term impact of magnetic resonance imaging (MRI) on nasopharyngeal carcinoma (NPC) detection in screening remains unclear as a result of limited follow-up. METHODS: A prospective population-based screening study was conducted in Southern China from October 2014 to November 2018 among Epstein-Barr virus (EBV)-seropositive individuals aged 30-69 years. EBV-seropositive participants underwent both endoscopy and MRI. Suspicious findings from either modality triggered a second endoscopy with biopsy. Followup for cancer diagnoses was completed via multiple methods in October 2023. Primary end points included the 5-year NPC detection rate (overall and by stage) and the false-negative rate. Secondary end points were sensitivity, specificity, positive predictive value (PPV), and referral rate. RESULTS: The analysis included 814 individuals (455 females; 56%) with a median age of 53 years (interquartile range, 46-60 years). Thirty-two NPC cases were detected (30 via MRI; 21 via endoscopy) over 5 years. MRI showed a significantly higher overall NPC detection rate (36.9 [95% CI, 25.9-52.1] vs. 25.8 [95% CI, 16.9-39.1] per 1000; p = .007) and early-stage tumor detection (20.9 [95% CI, 13.1-27.1] vs. 12.3 [95% CI, 6.7-22.5] per 1000; p = .020) than endoscopy. MRI also demonstrated a lower false-negative rate (3.0 [95% CI, 0.8-11.0] vs. 14.9 [95% CI, 8.4-26.5] per 1000; p = .024) and higher sensitivity (93.8% vs. 65.6%; p = .007) but lower specificity (84.0% vs. 92.8%; p < .001) and PPV (19.6% vs. 27.6%; p = .019). CONCLUSIONS: Single MRI demonstrated superior NPC detection versus endoscopy, particularly for early-stage tumors, in high-risk populations during a 5-year period, which suggests the potential for extending the rescreening interval to 5 years for MRI-negative individuals.