Yi X H, Lai H C, Liu J Z, Lin S C, Li C, Chen X Q, Wang D S
Department of Otolaryngology Head and Neck Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018 Nov;32(22):1740-1744. doi: 10.13201/j.issn.1001-1781.2018.22.014.
To compare the performances of VCA-IgA, EA-IgA and Rta-IgG in the diagnosis of nasopharyngeal carcinoma, and find the most appropriate combined interpretation scheme. The current study included a total of 346 subjects. Ninety-six subjects were nasopharyngeal carcinoma cases which were pathologically verified by the biopsy under electronic laryngoscope. The remaining 250 subjects, who received EBV tests at the same period, were normal healthy individuals without nasopharyngeal carcinoma. VCA-IgA, EA-IgA and Rta-IgG were detected in all cases. The clinial data were analyzed retrospectively. Best cutoff points of VCA-IgA, EA-IgA and Rta-IgG in the diagnosis of nasopharyngeal carcinoma were 1.37 s/co, 0.706 s/co and 0.817 s/co; the sensitivities were 88.5%,49.0% and 65.6%; the specificities were 88.8%,96.0% and 95.2%, respectively. The diagnostic accuracy of VCA-IgA was significantly higher than that of EA-IgA and Rta-IgG (<0.05). Three combined interpretation schemes were developed based on the VCA-IgA: ①VCA-IgA+EA-IgA; ②VCA-IgA+Rta-IgG; ③VCA-IgA+EA-IgA+Rta-IgG. Compared to the VCA-IgA, all the combined interpretation schemes had increased sensitivities and decreased specificities. The scheme 3 had the highest sensitivity. And the scheme 2 had the highest Youden index, and a comparable diagnosis accuracy to that of VCA-IgA (>0.05). VCA-IgA, EA-IgA and Rta-IgG were all helpful indicators in the diagnosis of nasopharyngeal carcinoma. VCA-IgA was more accurate than the EA-IgA and Rta-IgG. Combined interpretation schemes were helpful in improving the sensitivity. Because the clinical symptoms of nasopharyngeal carcinoma are often insidious and the missed diagnosis by serological examination may lead to serious consequences. It is of clinical value to adopt the combined interpretation schemes to improve the diagnostic sensitivity of nasopharyngeal carcinoma.
比较VCA-IgA、EA-IgA和Rta-IgG在鼻咽癌诊断中的性能，并找出最合适的联合解读方案。本研究共纳入346名受试者。96名受试者为鼻咽癌病例，经电子喉镜活检病理证实。其余250名同期接受EBV检测的受试者为无鼻咽癌的正常健康个体。对所有病例检测VCA-IgA、EA-IgA和Rta-IgG。对临床资料进行回顾性分析。VCA-IgA、EA-IgA和Rta-IgG在鼻咽癌诊断中的最佳截断值分别为1.37 s/co、0.706 s/co和0.817 s/co；敏感性分别为88.5%、49.0%和65.6%；特异性分别为88.8%、96.0%和95.2%。VCA-IgA的诊断准确性显著高于EA-IgA和Rta-IgG（<0.05）。基于VCA-IgA制定了三种联合解读方案：①VCA-IgA+EA-IgA；②VCA-IgA+Rta-IgG；③VCA-IgA+EA-IgA+Rta-IgG。与VCA-IgA相比，所有联合解读方案的敏感性均增加，特异性均降低。方案3的敏感性最高。方案2的约登指数最高，诊断准确性与VCA-IgA相当（>0.05）。VCA-IgA、EA-IgA和Rta-IgG均为鼻咽癌诊断的有用指标。VCA-IgA比EA-IgA和Rta-IgG更准确。联合解读方案有助于提高敏感性。由于鼻咽癌的临床症状往往隐匿，血清学检查漏诊可能导致严重后果。采用联合解读方案提高鼻咽癌诊断敏感性具有临床价值。
