Nasopharyngeal carcinoma diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Diagnostic Study of Choice

Study of choice

[Name of the investigation] is the gold standard test for the diagnosis of [disease name].

OR

The following result of [gold standard test] is confirmatory of [disease name]:

• [Result 1]
• [Result 2]

OR

[Name of the investigation] must be performed when:

• The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
• A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.

OR

[Name of the investigation] is the gold standard test for the diagnosis of [disease name].

OR

The diagnostic study of choice for [disease name] is [name of the investigation].

OR

There is no single diagnostic study of choice for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].

OR

[Disease name] is primarily diagnosed based on the clinical presentation.

OR

Investigations:

• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
• Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.

The comparison of various diagnostic studies for [disease name]

Test	Sensitivity	Specificity
Test 1	...%	...%
Test 2	...%	...%

[Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity

Diagnostic results

The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:

• [Finding 1]
• [Finding 2]

Sequence of Diagnostic Studies

The [name of investigation] must be performed when:

• The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
• A positive [test] is detected in the patient, to confirm the diagnosis.

OR

The various investigations must be performed in the following order:

• [Initial investigation]
• [2nd investigation]

Name of Diagnostic Criteria

It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.

[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].

OR

There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].

OR

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

[Disease name] may be diagnosed at any time if one or more of the following criteria are met:

• Criteria 1
• Criteria 2
• Criteria 3

OR

IF there are clear, established diagnostic criteria

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

IF there are no established diagnostic criteria

There are no established criteria for the diagnosis of [disease name].

Staging

American Joint Committee on Cancer (AJCC) Staging

The table below summarizes the TNM staging system for the diagnosis of nasopharyngeal carcinoma:

TNM	Description
TX	The primary tumor cannot be assessed
T0	No evidence of primary tumor, but EBV-positive cervical node(s) involvement
Tis	Carcinoma in situ
T1	Tumor confined to nasopharynx, or extension to oropharynx and/or nasal cavity without parapharthe yngeal involvement
T2	Tumor with extension to parapharyngeal space and/or infiltration of the medial pterygoid, lateral pterygoid, and/or prevertebral muscles
T3	Tumor invades bony structures of skull base cervical vertebra, pterygoid structures, and/or paranasal sinuses
T4	Tumor with intracranial extension and/or involvement of cranial nerves, hypopharynx, orbit, parotid gland and/or infiltration beyond the lateral surface of the lateral pterygoid muscle
Regional Lymph Nodes
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph nodes involved
N1	Unilateral metastasis, in cervical lymph node(s), and/or unilateral, or bilateral metastasis in retropharyngeal lymph nodes, 6 cm or less, above the caudal border of Cricoid cartilage
N2	Bilateral metastasis in cervical lymph node(s), 6 cm or less above the caudal border of Cricoid cartilage
N3	Metastasis in cervical lymph node(s) greater than 6 cm in dimension and/or extension below the caudal border of Cricoid cartilage
Distant Metastasis
M0	No distant metastasis
M1	Distant metastasis is present

Stage grouping
Stage	T	N	M
0	Tis	N0	M0
I	T1	N0	M0
II	T2a	N0	M0
II	T2b	N0	M0
III	T3	N0	M0
	T1	N1	M0
	T2	N1	M0
	T3	N1	M0
IVA	T4a	N0	M0
	T4a	N1	M0
	T1	N2	M0
	T2	N2	M0
	T3	N2	M0
	T4a	N2	M0
IVB	AnyT	N3	M0
	T4b	AnyN	M0
IVC	AnyT	AnyN	M1

Stage	T	N	M
0	Tis	N0	M0
I	T1	N0	M0
II	T1	N0,N1	M0
	T2	N0,N1	M0
III	T0, T1, T2	N2	M0
	T3	N0, N1, N2	M0
IVA	T4	N0, N1, N2	M0
	Any T	N3	M0
IVB	Any T	Any N	M1