EBV-Based Screening Methods for Identifying Nasopharyngeal Carcinoma

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In a Taiwanese study reported in the Journal of Clinical Oncology, Lou et al compared two methods of Epstein-Barr virus (EBV) screening to identify nasopharyngeal carcinoma.

Study Details

Blood samples were obtained from 819 incident Taiwanese nasopharyngeal carcinoma cases (including 213 cases of early-stage disease) diagnosed between 2010 to 2014, as well as from 1,768 controls matched for age and sex from the same region. EBV assessments consisted of an EBV antibody score using immunoglobulin A antibodies measured by enzyme-linked immunosorbent assay (EBV antibody score), and plasma EBV DNA load measured by real-time polymerase chain reaction followed by next-generation sequencing among EBV DNA-positive individuals (EBV DNA algorithm).

Key Findings

EBV antibodies were measured in 802 cases and 1,720 controls. EBV DNA load was measured in 797 cases and 1,745 controls. Among 898 individuals who tested positive for EBV DNA, 442 (49%; 322 cases and 120 controls) were able to undergo next-generation sequencing.

The EBV antibody score had a sensitivity of 88.4% (95% confidence interval [CI] = 86.1%–90.6%) and a specificity of 94.9% (95% CI = 93.8%–96.0%) for nasopharyngeal carcinoma. The EBV DNA algorithm yielded significantly higher sensitivity (93.2%, 95% CI = 91.3%–94.9%, P = 1.33 x 10-4) and specificity (98.1%, 95% CI = 97.3%–98.8%, P = 3.53 x 10-7).

Sensitivity of the EBV antibody score did not differ for stage I/II vs stage III/IV disease (87.1% vs 89.3%). Sensitivity of the EBV DNA algorithm was greater in stage III/IV disease vs stage I/II disease (96.1% vs 87.0%); no significant difference in sensitivities in stage I/II disease was observed (P = .514).

The investigators concluded: “We demonstrated high sensitivity and specificity of EBV antibody and plasma EBV DNA for nasopharyngeal carcinoma detection, with slightly inferior performance of the EBV antibody score. Cost-effectiveness studies are needed to guide screening implementation.”

K.C. Allen Chan, PhD, of the Department of Chemical Pathology, Prince of Wales Hospital, Hong Kong SAR, China, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by grants from Academia Sinica, Taiwan, the U.S. National Cancer Institute, National Science Foundation of China/Research Grant Council Joint Research Scheme, and others. For full disclosures of the study authors, visit

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