Objective To explore the value of narrow band imaging (NBI) combined with aniline blue staining in endoscopic screening and diagnosis of nasopharyngeal carcinoma. Methods From Oct. 2017 to Oct. 2021, 68 patients with suspected nasopharyngeal space-occupying lesions were selected from Gongli Hospital of Naval Medical University (Second Military Medical University) and The First People’s Hospital of Yinchuan. Electronic nasopharyngoscope with NBI was used for nasopharyngeal examination. Meanwhile, the effusion on the surface of the suspected lesions was stained with aniline blue, and the suspected lesions were examined by pathological biopsy. With the pathological results as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Kappa value of white light mode, NBI, aniline blue staining and NBI combined with aniline blue staining were calculated, and χ² test was used to compare the diagnostic positive rates of the above 4 examination methods. Results The positive rate of the combined diagnosis was significantly higher than those of white light endoscopy, NBI and aniline blue staining alone (97.83% ［45/46］ vs 56.52% ［26/46］, 84.78% ［39/46］, and 80.43% ［37/46］, all P＜0.001). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of NBI combined with aniline blue staining for nasopharyngeal carcinoma were 97.83%, 86.36%, 93.75%, 95.00% and 94.12%, respectively. The diagnostic results of NBI combined with aniline blue staining for nasopharyngeal carcinoma were in good consistency with the pathological findings (Kappa value was 0.862). Conclusion Compared with white light mode, NBI or aniline blue staining alone, NBI combined with aniline blue staining has higher sensitivity and specificity for the diagnosis of nasopharyngeal carcinoma.