Combining Transoral Nasopharyngeal Brush and Plasma Epstein-Barr Virus DNA in Detecting Locally Recurrent Nasopharyngeal Carcinoma

ObjectiveTo evaluate the sensitivities and specificities of Epstein-Barr virus (EBV) DNA in the detection of locally recurrent or persistent nasopharyngeal carcinoma (NPC) through nasopharyngeal (NP) brush biopsy and plasma, respectively, and whether a combination of both would be superior to the individual tests. Study DesignA case-control study was conducted from September 2016 to June 2022. SettingA multicentre study at 3 tertiary referral centers in Hong Kong was conducted by the Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong. MethodsTwenty-seven patients with biopsy-confirmed locally recurrent NPC were recruited as study subjects. Magnetic resonance imaging was performed to rule out regional recurrence. The control group consisted of 58 patients with a prior history of NPC who were now disease-free based on endoscopic and imaging findings. Patients underwent both the transoral NP brush (NP Screen (R)) and blood for plasma Epstein-Barr DNA levels. ResultsThe sensitivity and specificity of the combined modalities were 84.62% and 85.19%, respectively. The positive predictive value was 73.33% and the negative predictive value was 92.0%. ConclusionThe combination of NP brush biopsy and plasma EBV DNA is potentially an additional surveillance modality in detecting the local recurrence of NPC. Further study with a larger sample size would be required to validate the cutoff values.

Automated summary

This study evaluated the sensitivities and specificities of Epstein-Barr virus (EBV) DNA in detecting locally recurrent or persistent nasopharyngeal carcinoma (NPC) through nasopharyngeal (NP) brush biopsy and plasma, and investigated whether a combination of both tests would yield better results. The combined modalities had a sensitivity of 84.62%, specificity of 85.19%, positive predictive value of 73.33%, and negative predictive value of 92.0%. In conclusion, the combination of NP brush biopsy and plasma EBV DNA could be an additional surveillance method for detecting local recurrence of NPC.