(1) Anterior Nasal Endoscopy
After nasal mucosa contraction, the posterior nasal aperture and nasopharynx can be visualized through anterior rhinoscopy, allowing detection of tumors invading or adjacent to the nostrils.
(II) Indirect Nasopharyngoscopy
This method is simple and practical; the nasopharynx should be examined sequentially along each of its walls. Pay special attention to the posterior roof of the nasopharynx and the bilateral pharyngeal recesses, comparing corresponding areas on both sides. Any asymmetric submucosal elevations or isolated nodules detected on either side warrant particular concern.
(III) Fiberoptic Nasopharyngoscopy
A fiberoptic nasopharyngoscopy can be performed by first applying a 1% ephedrine solution to constrict the nasal mucosa and widen the nasal passages, followed by surface anesthesia of the nasal passages with a 1% lidocaine solution. The fiberoscope is then gently inserted through the nostril, allowing the examiner to visually guide it forward until it reaches the nasopharynx. This method is simple and provides stable visualization, though the posterior nasal aperture and anterior roof of the nasopharynx may not be fully visible.
(IV) Neck Biopsy
For cases where a nasopharyngeal biopsy has failed to provide a definitive diagnosis, a biopsy of the cervical lymph node mass can be performed. This procedure is typically carried out under local anesthesia. During surgery, clinicians should select the earliest-appearing, firm lymph node and aim to remove it entirely, including its capsule. If excisional biopsy proves particularly challenging, a wedge-shaped sample can be taken directly from the mass. When collecting tissue for biopsy, ensure sufficient depth while carefully avoiding excessive squeezing. Finally, after the procedure, avoid overly tight or dense suturing of the surgical site.
(V) Fine-needle aspiration
This is a simple, convenient, safe, and highly effective method for tumor diagnosis that has gained considerable popularity in recent years. For patients suspected of having cervical lymph node metastasis, fine-needle aspiration can be used first to obtain cellular samples. The specific procedure is as follows:
1. Nasopharyngeal Mass Aspiration: Using a No. 7 long needle attached to a syringe, after local anesthesia of the oropharynx, the needle is inserted into the tumor tissue under indirect nasopharyngoscopy. By gently pulling back on the syringe to create negative pressure, the needle can be moved back and forth within the tumor twice. The aspirated material is then spread onto a slide for cytological examination.
2. Fine-needle aspiration of cervical masses: Attach a No. 7 or No. 9 needle to a 10 mL syringe. After disinfecting the local skin, select an appropriate puncture site and insert the needle along the long axis of the tumor. Aspirate by pulling back on the syringe, then gently move the needle back and forth within the mass 2–3 times. Finally, withdraw the needle and examine the aspirated material using cytology or histopathology.
(6) EB Virus Serological Testing
Currently, the widely used method involves detecting EB virus IgA/VCA and IgA/EA antibody titers using immunoenzymatic assays. The former offers higher sensitivity but lower accuracy, while the latter is the exact opposite. Therefore, for individuals suspected of having nasopharyngeal carcinoma, it is advisable to perform tests for both types of antibodies simultaneously, as this can significantly aid in early diagnosis. In cases where IgA/VCA titers are ≥1:40 and/or IgA/EA titers are ≥1:5— even if no abnormalities are observed in the nasopharynx—patients should undergo exfoliative cytology or biopsy from areas known to be prone to nasopharyngeal cancer. If a definitive diagnosis remains elusive, regular follow-up is essential, with additional biopsies potentially required at later stages.
(7) Lateral Nasopharyngeal View, Skull Base Radiograph, and CT Scan
Each patient should routinely undergo lateral nasopharyngeal and skull base radiographs. If there is suspicion of involvement in the paranasal sinuses, middle ear, or other areas, corresponding imaging studies should be performed concurrently. Facilities with the necessary resources should also conduct CT scans to assess local tumor extension—particularly to accurately determine the extent of infiltration within the parapharyngeal space. This information is critical for staging the disease and guiding the development of an appropriate treatment plan.
(8) Type B Ultrasound Examination
Type B ultrasound has been widely used in the diagnosis and treatment of nasopharyngeal carcinoma due to its simplicity, non-invasive nature, and high patient acceptance. In nasopharyngeal cancer cases, it is primarily employed to examine the liver, retroperitoneal lymph nodes in the neck and abdomen, as well as pelvic lymph nodes, helping clinicians determine whether liver metastases are present and assess whether lymph node densities exhibit cystic features.
(9) Magnetic Resonance Imaging Examination
Since magnetic resonance imaging (MRI) clearly visualizes the brain's gyri, sulci, gray matter, white matter, ventricles, cerebrospinal fluid pathways, and blood vessels at all cranial levels, using the SE technique to generate T1- and T2-weighted high-intensity images allows for the diagnosis of nasopharyngeal cancer, maxillary sinus cancer, and other conditions—and also helps assess the tumor's relationship with surrounding tissues. For more information, please call the Taixinsheng hotline at 010-51571020.