The contact bleeding sign of nasopharyngeal carcinoma

The nasopharynx has lymphoepithelium frequently resulting in mucosal irregularities. Therefore, it is often difficult by mere inspection to clinically differentiate nasopharyngeal carcinoma (NPC) from normal tissue. The present study aimed to determine if contact bleeding could be used as a reliable sign to help differentiate the two.

Fifty consecutive Chinese adult patients with mucosal masses in the nasopharynx suspicious of being NPC were studied. Contact bleeding, if present, was elicited with a swab stick and viewed with a nasal endoscope. Each mass was then biopsied and examined histologically.

Twenty-one patients were histologically proven to have NPC and all had contact bleeding (sensitivity rate of 100%). Of those patients who did not have NPC, 10 had contact bleeding (specificity rate of 65.5%) but 90.0% of them exhibited signs and/or symptoms of rhinosinusitis. After the rhinosinusitis was successfully treated, the masses either resolved or exhibited no further contact bleeding.

Illiciting contact bleeding on masses in the postnasal space is inexpensive, safe, and easy. In many cases, it helps the clinician decide if certain masses warrant biopsies to exclude NPC.