Improved accuracy of detection of nasopharyngeal carcinoma by combined application of circulating Epstein-Barr virus DNA and anti-Epstein-Barr viral capsid antigen IgA antibody
Improved accuracy of detection of nasopharyngeal carcinoma by combined application of circulating Epstein-Barr virus DNA and anti-Epstein-Barr viral capsid antigen IgA antibody
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DOI：
10.1373/clinchem.2003.022426
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发表时间：
2004-02-01
影响因子：
9.3
通讯作者：
Lo, YMD
中科院分区：
文献类型：
--
作者：
Leung, SF;Tam, JS;Lo, YMD
背景资料：方法：对139例初治鼻咽癌患者和178例健康人外周血中EB病毒（EBV）DNA和抗EB病毒衣壳抗原伊加（伊加VCA）进行了检测，并对两种标志物的敏感性和特异性进行了比较。还在筛查诊所鉴定为具有假阳性IgA-VCA结果的36名健康家庭成员中评估了EBV DNA。通过实时定量PCR测定EBV DNA，检测限为60拷贝/mL。结果：EBVDNA和IgA-VCA对鼻咽癌诊断的敏感性分别为95%（95%可信区间为91-98%）和81%（73-87%）。组合标志物组的总体灵敏度（任一标志物的阳性结果）为99%。两种标记物的浓度均显示出对癌症分期的依赖性。EBV-DNA和IgA-VCA的特异性分别为98%（96-99%）和96%（91-98%）。在36个健康的家庭成员与假阳性的IgA-VCA结果，四分之三检测不到的EBV DNA，而其他人的EBV DNA浓度增加，显着低于NPC patients.Conclusions：对于NPC的诊断，EBV DNA识别几乎所有的假阴性IgA-VCA的情况下，并给出了99%的诊断敏感性结合IgA-VCA。在筛查环境中，EBV DNA鉴定了四分之三的IgA-VCA假阳性病例。在基于IgA-VCA的筛查方案中选择性应用EBV DNA可以提高筛查准确性，而成本仅适度增加。(C)2004年美国临床化学协会。
Background: Circulating Epstein-Barr viral (EBV) DNA and anti-EBV capsid antigen IgA (IgA VCA) represent two of the most sensitive peripheral blood markers of nasopharyngeal carcinoma (NPC), but direct comparative studies of these two markers are lacking.Methods: The sensitivities and specificities of IgA-VCA and EBV DNA for diagnosis of NPC were determined in 139 new cases of NPC and 178 healthy individuals, respectively. EBV DNA was also assessed in 36 healthy family members identified as having false-positive IgA-VCA results at a screening clinic. EBV DNA was measured by a real-time quantitative PCR assay with a detection limit of 60 copies/mL. IgA-VCA was measured by semiquantitative indirect immunofluorescent method; a titer greater than or equal to1/10 was taken as positive.Results: The sensitivities of EBV DNA and IgA-VCA for diagnosis of NPC were 95% (95% confidence interval, 91-98%) and 81% (73-87%), respectively. The combined marker panel had an overall sensitivity (positive result by either marker) of 99%. The concentrations of both markers showed dependence on cancer stage. The specificities of EBV DNA and IgA-VCA were 98% (96-99%) and 96% (91-98%), respectively. Among 36 healthy family members with false-positive IgA-VCA results, three-fourths had undetectable EBV DNA, whereas the others had increased EBV DNA concentrations that were significantly lower than in NPC patients.Conclusions: For diagnosis of NPC, EBV DNA identifies almost all false-negative IgA-VCA cases and gives a 99% diagnostic sensitivity when combined with IgA-VCA. In the screening setting, EBV DNA identifies three-fourths of false-positive IgA-VCA cases. The selective application of EBV DNA in an IgA-VCA-based screening protocol could improve screening accuracy with only moderate increases in cost. (C) 2004 American Association for Clinical Chemistry.