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News

Plasma Epstein–Barr virus DNA to screen for nasopharyngeal cancer

This week's New England Journal of Medicine analyzed plasma Epstein–Barr virus DNA to screen for nasopharyngeal cancer.

News image

Circulating cell-free Epstein–Barr virus (EBV) DNA is a biomarker for nasopharyngeal carcinoma.

Dr Allen Chan and colleagues conducted a prospective study to investigate whether EBV DNA in plasma samples would be useful to screen for early nasopharyngeal carcinoma in asymptomatic persons.

The researchers analyzed EBV DNA in plasma specimens to screen participants who did not have symptoms of nasopharyngeal carcinoma.

Participants with initially positive results were retested approximately 4 weeks later, and those with persistently positive EBV DNA in plasma underwent nasal endoscopic examination and magnetic resonance imaging (MRI).

A total of 20,174 participants underwent screening.

Sensitivity of EBV DNA in plasma samples in screening for nasopharyngeal carcinoma were 97%
New England of Journal Medicine

The researchers found that EBV DNA was detectable in plasma samples obtained from 1112 participants, and 309 of all participants.

The team noted that 28% of those who initially tested positive had persistently positive results on the repeated sample.

Among these 309 participants, 300 underwent endoscopic examination, and 275 underwent both endoscopic examination and MRI.

Of these participants, the researchers found that 34 had nasopharyngeal carcinoma.

A significantly higher proportion of participants with nasopharyngeal carcinoma that was identified by screening had stage I or II disease than in a historical cohort, and had superior 3-year progression-free survival.

The researchers noted that 9 participants declined to undergo further testing, and 1 of them presented with advanced nasopharyngeal carcinoma 32 months after enrollment.

Nasopharyngeal carcinoma developed in only 1 participant with negative EBV DNA in plasma samples within 1 year after testing.

The team observed that sensitivity and specificity of EBV DNA in plasma samples in screening for nasopharyngeal carcinoma were 97% and 99%, respectively.

Dr Chan's team concludes, "Analysis of EBV DNA in plasma samples was useful in screening for early asymptomatic nasopharyngeal carcinoma."

"Nasopharyngeal carcinoma was detected significantly earlier and outcomes were better in participants who were identified by screening than in those in a historical cohort."

NEJM 2017; 377:513-522
11 August 2017

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