通过鼻咽拭子检测潜伏膜蛋白1（LMP-1）基因筛查鼻咽癌。

Screening nasopharyngeal carcinoma by detection of the latent membrane protein 1 (LMP-1) gene with nasopharyngeal swabs.

作者信息

Hao Sheng-Po, Tsang Ngan-Ming, Chang Kai-Ping

机构信息

Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, Republic of China.

出版信息

Cancer. 2003 Apr 15;97(8):1909-13. doi: 10.1002/cncr.11312.

DOI:10.1002/cncr.11312

PMID:12673717

Abstract

BACKGROUND

Nasopharyngeal carcinoma (NPC) is a common head and neck cancer in Taiwan. The goals of the current study were to investigate whether a nasopharyngeal swab technique could provide enough DNA for polymerase chain reaction (PCR) analysis of the Epstein-Barr virus (EBV)-derived latent membrane protein 1 (LMP-1) gene and to determine the feasibility and reliability of diagnosing NPC by detection of LMP-1 in the nasopharynx.

METHODS

320 adults underwent nasopharyngoscopy and nasopharyngeal swab to obtain cells for the LMP-1 PCR assay; some patients also underwent nasopharyngeal biopsy.

RESULTS

An amount of DNA that was sufficient for PCR was extracted from 96.3% of the swab samples. By detecting LMP-1 in nasopharyngeal swabs, NPC was diagnosed with a false positive rate of 12.7% (7 of 55 patients), a false negative rate of 1.6% (4 of 253 patients), sensitivity of 87.3% (48 of 55 patients), specificity of 98.4% (249 of 253 patients), a positive predictive value of 92.3% (48 of 52 patients), and a negative predictive value of 97.3% (249/256 patients). NPC was diagnosed by nasopharyngoscopy with a false positive rate of 38% (30 of 79 patients), a false negative rate of 0.4% (1 of 241 patients), sensitivity of 62% (49 of 79 patients), specificity of 99.6% (240 of 241 patients), a positive predictive value of 98% (49 of 50 patients), and a negative predictive value of 88.9% (240 of 270 patients). Only 7 (0.2%) of 256 patients with a diagnosis other than NPC had LMP-1 detected in the nasopharyngeal space.

CONCLUSIONS

Detecting EBV genomic LMP-1 by nasopharyngeal swab diagnosed NPC with 87.3% sensitivity and 98.4% specificity. EBV genomic DNA usually is not detected by PCR-based methods in the nasopharyngeal space. Its incidence is estimated to be as low as 0.2% among the general population. The nasopharyngeal swab coupled with PCR-based EBV LMP-1 detection could serve as part of a screening program for high-risk populations.

摘要

背景

鼻咽癌（NPC）是台湾常见的头颈部癌症。本研究的目的是调查鼻咽拭子技术是否能提供足够的DNA用于对爱泼斯坦-巴尔病毒（EBV）衍生的潜伏膜蛋白1（LMP-1）基因进行聚合酶链反应（PCR）分析，并通过检测鼻咽部的LMP-1来确定诊断NPC的可行性和可靠性。

方法

320名成年人接受了鼻咽镜检查和鼻咽拭子检查，以获取用于LMP-1 PCR检测的细胞；部分患者还接受了鼻咽活检。

结果

96.3%的拭子样本提取出了足以进行PCR的DNA量。通过检测鼻咽拭子中的LMP-1，诊断NPC的假阳性率为12.7%（55名患者中的7名），假阴性率为1.6%（253名患者中的4名），敏感性为87.3%（55名患者中的48名），特异性为98.4%（253名患者中的249名），阳性预测值为92.3%（52名患者中的48名），阴性预测值为97.3%（256名患者中的249名）。通过鼻咽镜检查诊断NPC的假阳性率为38%（79名患者中的30名），假阴性率为0.4%（241名患者中的1名），敏感性为62%（79名患者中的49名），特异性为99.6%（241名患者中的240名），阳性预测值为98%（50名患者中的49名），阴性预测值为88.9%（270名患者中的240名）。在256名非NPC诊断的患者中，只有7名（0.2%）在鼻咽部检测到LMP-1。