Combined MRI and peripheral blood EBV testing enhances the diagnosis of nasopharyngeal carcinoma

BACKGROUND: MRI is the preferred imaging modality for staging of confirmed nasopharyngeal carcinoma (NPC) per the 8th UICC/AJCC system, but its diagnostic performance in patients with suspected NPC remains unclear. OBJECTIVES: To evaluate the clinical value of MRI combined with peripheral blood EBV detection in the diagnosis of NPC. METHODS: This retrospective analysis enrolled patients with suspected NPC from a tertiary hospital between September 2022 and June 2023. Using histopathology as the reference standard, we evaluated the diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC)) of nasopharyngeal MRI and EBV serology. Receiver operating characteristic (ROC) curve analysis was performed to calculate AUCs and optimal thresholds. Cases involving discordance between pathological and MRI diagnoses were further evaluated. RESULTS: The combined application of MRI and peripheral blood EBV testing demonstrated excellent diagnostic performance for the diagnosis of NPC (AUC: 0.979). The novel integrated MRI-EBV testing strategy mitigates the inflammation-related diagnostic limitations of unimodal testing for NPC, preventing misdiagnosis, improving lymphoma differentiation and reducing pathological missed diagnoses. CONCLUSIONS: MRI and EBV testing are highly valuable for NPC screening, and their combined application shows superior diagnostic efficacy and clinical utility, pending prospective multi-center validation.