The use of brush cytology and directed biopsies for the detection of nasopharyngeal carcinoma and precursor lesions

Abstract

The cytologic pickup of NPC was substantially lower than that obtained on biopsy. More importantly, NPIN was uncommon. Therefore, a screening test that depends on the collection of cells for the microscopic diagnosis of NPIN and NPC is unlikely to have a major impact on the incidence of NPC. Furthermore, obtaining a good cytologic specimen from the nasopharynx is not simple, and this further limits this technique for mass screening purposes. The concept of a cytologic test for NPC, similar to the Pap test for the prevention of uterine cervix cancer, has still to be realized.

Noninvasive diagnosis of nasopharyngeal carcinoma: Nasopharyngeal brushings reveal high Epstein‐Barr virus DNA load and carcinoma‐specific viral BARF1 mRNA

“…NPC cells at the surface may also be obscured by blood or tumour detritus. 43 However, in our study, we did not find any correlation between NP bleeding and EBV DNA levels (data not shown). Moreover, there is a possibility that a deeply located tumour is missed by the NP brushing procedure, while the deep biopsy may be able to yield sufficient number of tumour cells in such case.…”

“…11 Monitoring of EBV parameters reflecting increased viral burden and carcinoma-specific transcriptional activity is more sensitive and specific than previously described cytological evaluation of NP brushing smears (Refs. 43,44 ; Harijadi et al, unpublished data).…”

“…Moreover, there is a possibility that a deeply located tumour is missed by the NP brushing procedure, while the deep biopsy may be able to yield sufficient number of tumour cells in such case. 27,43 It is not uncommon that multiple biopsies are needed in some patients to make definite NPC diagnosis. 25 The NP brushing procedure has a false negativity rate comparable to that of the diagnostic NP biopsy.…”

Epstein-Barr Virus DNA Load in Nasopharyngeal Brushings and Whole Blood in Nasopharyngeal Carcinoma Patients before and after Treatment

“…Overall, nasopharyngeal brushing proved to be a specific and minimal invasive diagnostic tool for NPC diagnosis. However, the possibility remains that a deeply located tumor is missed by the nasopharyngeal bushing procedure, whereas a deep biopsy may be able to yield sufficient number of tumor cells for making a diagnosis (30). This can only be confirmed in more extensive studies.…”

“…A negative result (5%) of EBV-DNA viral load brush might be caused by absence of cancer cells or obscured by blood, by tumor detritus, or due to improper sampling. Both primary and recurrent cancers may be located deep under the overlying mucosa and early lesions not invading the nasopharyngeal surface can be difficult to detect when biopsy or brushing is done too superficially (30). Contrary, NPC tumor-derived EBV-DNA from submucosal locations may reach the surface (shedding) leading to detectable aberrant levels in the brush.…”