European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 9, pp 2515–2520 | Cite as

Comparison of narrow-band imaging and conventional nasopharyngoscopy for the screening of unaffected members of families with nasopharyngeal carcinoma

  • Ching-Yin HoEmail author
  • Kee-Tak Chan
  • Pen-Yuan Chu
Head and Neck


Familial aggregation of nasopharyngeal carcinoma (NPC) has been widely reported. The excess risk is about 4–8-fold among first-degree relatives of NPC patients compared with those without a family history of the disease. We used nasopharyngoscopy and a narrow-band image system (NBI) to screen NPC high-risk patients and identify a good tool for the early detection of NPC in these high-risk groups. We recruited all available, affected blood relations of the patients. When NPC patients were more distant relatives, such as cousins, we recruited their shared second-degree relatives, such as unaffected aunts and uncles, to genetically connect the NPC cases. We performed transnasal endoscopy, first in white-light mode, then under the NBI system. There were two NBI patterns in NPC: microvascular proliferation and engorged blood vessels. The NBI pattern in normal nasopharyngeal mucosa was a regular cobblestone pattern. A prospective study included 211 asymptomatic members from 154 NPC families. We found four cases of NPC, all with a tumor stage of T1. In one patient (1/4), MRI revealed a 2-cm-diameter neck lymphadenopathy (N1). The correlation between conventional nasopharyngoscopy and NBI was very high (κ = 0.798, P = 0.000). In conclusions, NBI is not superior to conventional nasopharyngoscopy for the early detection of NPC in unaffected members of families with NPC history. The long-term follow-up is necessary in high-risk NPC patients. Further studies will be needed to determine which screening tool—conventional nasopharyngoscopy, NBI, or EB virus titer—is most effective.


Concomitant chemoradiotherapy EB virus titer Familial aggregation Narrow-band imaging Nasopharyngeal carcinoma Nasopharyngoscope 



Funding Support by V100C-038 from Taipei Veterans General Hospital and NSC 98-2314-B-075-016-MY3.


  1. 1.
    (2007) Department of Health TEY, Taiwan. Cancer registry annual reportGoogle Scholar
  2. 2.
    Wei WI, Sham JS (2005) Nasopharyngeal carcinoma. Lancet 365:2041–2054PubMedCrossRefGoogle Scholar
  3. 3.
    Sham JS, Choy D (1990) Prognostic factors of nasopharyngeal carcinoma: a review of 759 patients. Br J Radiol 63:51–58PubMedCrossRefGoogle Scholar
  4. 4.
    Chen CY, Han F, Zhao C, Lu LX, Sun Y, Liu XF, Lu TX (2009) Treatment results and late complications of 556 patients with locally advanced nasopharyngeal carcinoma treated with radiotherapy alone. Br J Radiol 82:452–458PubMedCrossRefGoogle Scholar
  5. 5.
    Lee AW, Sze WM, Au JS, Leung SF, Leung TW, Chua DT, Zee BC, Law SC, Teo PM, Tung SY, Kwong DL, Lau WH (2005) Treatment results for nasopharyngeal carcinoma in the modern era: the Hong Kong experience. Int J Radiat Oncol Biol Phys 61:1107–1116PubMedCrossRefGoogle Scholar
  6. 6.
    Ho JH (1972) Nasopharyngeal carcinoma (NPC). Adv Cancer Res 15:57–92PubMedCrossRefGoogle Scholar
  7. 7.
    Williams EH, de The G (1974) Letter: familial aggregation in nasopharyngeal carcinoma. Lancet 2:295–296PubMedCrossRefGoogle Scholar
  8. 8.
    Ung A, Chen CJ, Levine PH, Cheng YJ, Brinton LA, Chen IH, Goldstein AM, Hsu MM, Chhabra SK, Chen JY, Apple RJ, Yang CS et al (1999) Familial and sporadic cases of nasopharyngeal carcinoma in Taiwan. Anticancer Res 19:661–665PubMedGoogle Scholar
  9. 9.
    Hamamoto Y, Endo T, Nosho K, Arimura Y, Sato M, Imai K (2004) Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett’s esophagus. J Gastroenterol 39:14–20PubMedCrossRefGoogle Scholar
  10. 10.
    Machida H, Sano Y, Hamamoto Y, Muto M, Kozu T, Tajiri H, Yoshida S (2004) Narrow-band imaging in the diagnosis of colorectal mucosal lesions: a pilot study. Endoscopy 36:1094–1098PubMedCrossRefGoogle Scholar
  11. 11.
    Uedo N, Ishihara R, Iishi H, Yamamoto S, Yamada T, Imanaka K, Takeuchi Y, Higashino K, Ishiguro S, Tatsuta M (2006) A new method of diagnosing gastric intestinal metaplasia: narrow-band imaging with magnifying endoscopy. Endoscopy 38:819–824PubMedCrossRefGoogle Scholar
  12. 12.
    Muto M, Horimatsu T, Ezoe Y, Hori K, Yukawa Y, Morita S, Miyamoto S, Chiba T (2009) Narrow-band imaging of the gastrointestinal tract. J Gastroenterol 44:13–25PubMedCrossRefGoogle Scholar
  13. 13.
    van den Broek FJ, Reitsma JB, Curvers WL, Fockens P, Dekker E (2009) Systematic review of narrow-band imaging for the detection and differentiation of neoplastic and nonneoplastic lesions in the colon (with videos). Gastrointest Endosc 69:124–135PubMedCrossRefGoogle Scholar
  14. 14.
    Muto M, Nakane M, Katada C, Sano Y, Ohtsu A, Esumi H, Ebihara S, Yoshida S (2004) Squamous cell carcinoma in situ at oropharyngeal and hypopharyngeal mucosal sites. Cancer 101:1375–1381PubMedCrossRefGoogle Scholar
  15. 15.
    Watanabe A, Tsujie H, Taniguchi M, Hosokawa M, Fujita M, Sasaki S (2006) Laryngoscopic detection of pharyngeal carcinoma in situ with narrowband imaging. Laryngoscope 116:650–654PubMedCrossRefGoogle Scholar
  16. 16.
    Ugumori T, Muto M, Hayashi R, Hayashi T, Kishimoto S (2009) Prospective study of early detection of pharyngeal superficial carcinoma with the narrowband imaging laryngoscope. Head Neck 31:189–194PubMedCrossRefGoogle Scholar
  17. 17.
    Lin YC, Watanabe A, Chen WC, Lee KF, Lee IL, Wang WH (2010) Narrowband imaging for early detection of malignant tumors and radiation effect after treatment of head and neck cancer. Arch Otolaryngol Head Neck Surg 136:234–239PubMedCrossRefGoogle Scholar
  18. 18.
    Ho CY, Lee YL, Chu PY (2011) Use of narrow band imaging in evaluation of possible nasopharyngeal carcinoma. Am J Rhinol Allergy 25:107–111PubMedCrossRefGoogle Scholar
  19. 19.
    Wang WH, Lin YC, Lee KF, Weng HH (2011) Nasopharyngeal carcinoma detected by narrow-band imaging endoscopy. Oral Oncol 47:736–741PubMedCrossRefGoogle Scholar
  20. 20.
    Wang WH, Lin YC, Chen WC, Chen MF, Chen CC, Lee KF (2012) Detection of mucosal recurrent nasopharyngeal carcinomas after radiotherapy with narrow-band imaging endoscopy. Int J Radiat Oncol Biol Phys 83:1213–1219PubMedCrossRefGoogle Scholar
  21. 21.
    Friborg J, Wohlfahrt J, Koch A, Storm H, Olsen OR, Melbye M (2005) Cancer susceptibility in nasopharyngeal carcinoma families—a population-based cohort study. Cancer Res 65:8567–8572PubMedCrossRefGoogle Scholar
  22. 22.
    Ji X, Zhang W, Xie C, Wang B, Zhang G, Zhou F (2011) Nasopharyngeal carcinoma risk by histologic type in central China: impact of smoking, alcohol and family history. Int J Cancer 129:724–732PubMedCrossRefGoogle Scholar
  23. 23.
    Ng WT, Yau TK, Yung RW, Sze WM, Tsang AH, Law AL, Lee AW (2005) Screening for family members of patients with nasopharyngeal carcinoma. Int J Cancer 113:998–1001PubMedCrossRefGoogle Scholar
  24. 24.
    Zeng YX, Jia WH (2002) Familial nasopharyngeal carcinoma. Semin Cancer Biol 12:443–450PubMedCrossRefGoogle Scholar
  25. 25.
    Jia WH, Feng BJ, Xu ZL, Zhang XS, Huang P, Huang LX, Yu XJ, Feng QS, Yao MH, Shugart YY, Zeng YX (2004) Familial risk and clustering of nasopharyngeal carcinoma in Guangdong, China. Cancer 101:363–369PubMedCrossRefGoogle Scholar
  26. 26.
    Ng WT, Choi CW, Lee MC, Chan SH, Yau TK, Lee AW (2009) Familial nasopharyngeal carcinoma in Hong Kong: epidemiology and implication in screening. Fam Cancer 8:103–108PubMedCrossRefGoogle Scholar
  27. 27.
    Loh KS, Goh BC, Lu J, Hsieh WS, Tan L (2006) Familial nasopharyngeal carcinoma in a cohort of 200 patients. Arch Otolaryngol Head Neck Surg 132:82–85PubMedCrossRefGoogle Scholar
  28. 28.
    Chan AT, Teo PM, Leung TW, Leung SF, Lee WY, Yeo W, Choi PH, Johnson PJ (1995) A prospective randomized study of chemotherapy adjunctive to definitive radiotherapy in advanced nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 33:569–577PubMedCrossRefGoogle Scholar
  29. 29.
    Yeh SA, Tang Y, Lui CC, Huang YJ, Huang EY (2005) Treatment outcomes and late complications of 849 patients with nasopharyngeal carcinoma treated with radiotherapy alone. Int J Radiat Oncol Biol Phys 62:672–679PubMedCrossRefGoogle Scholar
  30. 30.
    Lin S, Lu JJ, Han L, Chen Q, Pan J (2010) Sequential chemotherapy and intensity-modulated radiation therapy in the management of locoregionally advanced nasopharyngeal carcinoma: experience of 370 consecutive cases. BMC Cancer 10:39PubMedCrossRefGoogle Scholar
  31. 31.
    Tham IW, Lin S, Pan J, Han L, Lu JJ, Wee J (2010) Intensity-modulated radiation therapy without concurrent chemotherapy for stage IIb nasopharyngeal cancer. Am J Clin Oncol 33:294–299PubMedGoogle Scholar
  32. 32.
    Afqir S, Ismaili N, Errihani H (2009) Concurrent chemoradiotherapy in the management of advanced nasopharyngeal carcinoma: current status. J Cancer Res Ther 5:3–7PubMedCrossRefGoogle Scholar
  33. 33.
    Lu H, Peng L, Yuan X, Hao Y, Lu Z, Chen J, Cheng J, Deng S, Gu J, Pang Q, Qin J (2009) Concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma: a treatment paradigm also applicable to patients in Southeast Asia. Cancer Treat Rev 35:345–353PubMedCrossRefGoogle Scholar
  34. 34.
    Chan AT, Hsu MM, Goh BC, Hui EP, Liu TW, Millward MJ, Hong RL, Whang-Peng J, Ma BB, To KF, Mueser M, Amellal N et al (2005) Multicenter, phase II study of cetuximab in combination with carboplatin in patients with recurrent or metastatic nasopharyngeal carcinoma. J Clin Oncol 23:3568–3576PubMedCrossRefGoogle Scholar
  35. 35.
    Licitra L, Bossi P, Locati LD, Bergamini C (2005) Is restoring platinum sensitivity the best goal for cetuximab in recurrent/metastatic nasopharyngeal cancer? J Clin Oncol 23:7757–7758 author reply 8–9PubMedCrossRefGoogle Scholar
  36. 36.
    Heng DM, Wee J, Fong KW, Lian LG, Sethi VK, Chua ET, Yang TL, Khoo Tan HS, Lee KS, Lee KM, Tan T, Chua EJ (1999) Prognostic factors in 677 patients in Singapore with nondisseminated nasopharyngeal carcinoma. Cancer 86:1912–1920PubMedCrossRefGoogle Scholar
  37. 37.
    Henle G, Henle W (1976) Epstein-Barr virus-specific IgA serum antibodies as an outstanding feature of nasopharyngeal carcinoma. Int J Cancer 17:1–7PubMedCrossRefGoogle Scholar
  38. 38.
    Fachiroh J, Paramita DK, Hariwiyanto B, Harijadi A, Dahlia HL, Indrasari SR, Kusumo H, Zeng YS, Schouten T, Mubarika S, Middeldorp JM (2006) Single-assay combination of Epstein-Barr Virus (EBV) EBNA1- and viral capsid antigen-p18-derived synthetic peptides for measuring anti-EBV immunoglobulin G (IgG) and IgA antibody levels in sera from nasopharyngeal carcinoma patients: options for field screening. J Clin Microbiol 44:1459–1467PubMedCrossRefGoogle Scholar
  39. 39.
    Fachiroh J, Prasetyanti PR, Paramita DK, Prasetyawati AT, Anggrahini DW, Haryana SM, Middeldorp JM (2008) Dried-blood sampling for epstein-barr virus immunoglobulin G (IgG) and IgA serology in nasopharyngeal carcinoma screening. J Clin Microbiol 46:1374–1380PubMedCrossRefGoogle Scholar
  40. 40.
    Hao SP, Tsang NM, Chang KP (2003) Screening nasopharyngeal carcinoma by detection of the latent membrane protein 1 (LMP-1) gene with nasopharyngeal swabs. Cancer 97:1909–1913PubMedCrossRefGoogle Scholar
  41. 41.
    Chien YC, Chen JY, Liu MY, Yang HI, Hsu MM, Chen CJ, Yang CS (2001) Serologic markers of Epstein-Barr virus infection and nasopharyngeal carcinoma in Taiwanese men. N Engl J Med 345:1877–1882PubMedCrossRefGoogle Scholar
  42. 42.
    Pickard A, Chen CJ, Diehl SR, Liu MY, Cheng YJ, Hsu WL, Sun B, Hsu MM, Chen IH, Chen JY, Yang CS, Mittl BL et al (2004) Epstein-Barr virus seroreactivity among unaffected individuals within high-risk nasopharyngeal carcinoma families in Taiwan. Int J Cancer 111:117–123PubMedCrossRefGoogle Scholar
  43. 43.
    Qin HD, Jia WH, Zhang LL, Liu N, Zhou XX, Wang MH, Feng QS, Chen LZ, Zhang Y, Jorgensen TJ, Zeng YX, Shugart YY (2011) Elevated Epstein-Barr virus seroreactivity among unaffected members of families with nasopharyngeal carcinoma. J Med Virol 83:1792–1798PubMedCrossRefGoogle Scholar
  44. 44.
    Chen B, Zheng YQ, Zhang ZG, Huang XM, Peng JR (2011) Application of narrow band imaging endoscopy in the diagnosis of nasopharyngeal lesions. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 46:50–53PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Otolaryngology, Taipei Veterans General Hospital and School of MedicineNational Yang-Ming UniversityTaipeiTaiwan

Personalised recommendations