FRCS (ORL-HNS) · SECTION 1 SBA

Nasopharyngeal carcinoma staging

A patient has biopsy-proven nasopharyngeal carcinoma and bilateral cervical nodes. Which imaging combination best supports initial staging?

CHOOSE ONE ANSWER

Best of five

  1. A. Plain sinus radiographs only
  2. B. MRI of the primary and skull base plus systemic staging with PET-CT where appropriate
  3. C. Ultrasound of the thyroid alone
  4. D. CT temporal bones without systemic staging
  5. E. Proceed to radiotherapy without cross-sectional imaging
ANSWER AND REASONING

B. MRI of the primary and skull base plus systemic staging with PET-CT where appropriate

MRI defines nasopharyngeal soft tissue, skull base and perineural spread; PET-CT assists nodal and distant staging. Imaging should precede definitive chemoradiotherapy planning.

Why every option is right or wrong

A. Plain sinus radiographs only: They cannot stage skull-base, nodal or distant disease.

B. MRI of the primary and skull base plus systemic staging with PET-CT where appropriate: MRI defines nasopharyngeal soft tissue, skull base and perineural spread; PET-CT assists nodal and distant staging. Imaging should precede definitive chemoradiotherapy planning.

C. Ultrasound of the thyroid alone: This does not assess the nasopharynx.

D. CT temporal bones without systemic staging: This is anatomically incomplete.

E. Proceed to radiotherapy without cross-sectional imaging: Treatment volumes and prognosis require accurate staging.

What if the scenario changed?

If renal function precluded contrast, sequences and alternative imaging would be adapted rather than omitting staging.

EDUCATIONAL USE

Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for current guidance, local policy and specialist judgement.

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