title: Epstein-Barr virus DNA load in nasopharyngeal brushings and whole blood in nasopharyngeal carcinoma patients before and after treatment.
abstract: OBJECTIVE
  Nasopharyngeal carcinoma (NPC) is consistently associated with Epstein-Barr virus (EBV) and highly prevalent in Indonesia. EBV-DNA load can be used for early diagnosis and may have prognostic value. In this study, EBV-DNA load was evaluated in minimal invasive nasopharyngeal (NP) brushings and whole blood for initial diagnosis and therapy assessment against the standard-of-care diagnosis by biopsy with EBV-RISH and standard EBV-IgA serology.
  
  
  METHODS
  NP brushings and blood samples were collected from 289 consecutive ENT patients suspected of NPCs and 53 local healthy controls. EBV-DNA load was quantified by real-time PCR and serology by peptide-based EBV-IgA ELISA. Tissue biopsies were examined by routine histochemistry and by EBER RNA in situ hybridization.
  
  
  RESULTS
  Repeated NP brushing was well tolerated by patients and revealed high viral load in the 228 NPC cases at diagnosis than 61 non-NPC cancer cases and healthy controls (P < 0.001). The diagnostic value of EBV-DNA load in blood and EBV-IgA serology was inferior to the NP brush results. The level of EBV-DNA load in brushes of patients with NPC was not related to T, N, or M stage, whereas elevated EBV-DNA load in blood correlated with N and M stage. EBV-DNA levels in brushings and whole blood showed a significant reduction at 2 months after treatment (P = 0.001 and P = 0.005, respectively), which was not reflected in EBV-IgA serology.
  
  
  CONCLUSIONS
  NP brush sampling combined with EBV-DNA load analysis is a minimal invasive and well-tolerated diagnostic procedure, suited for initial diagnosis and follow-up monitoring of NPCs.
authors.affiliation: Department of ENT, University of Indonesia, Dr. Cipto Mangunkusumo Hospital Jakarta, Indonesia.
authors.forename: Marlinda
authors.initials: M
authors.lastname: Adham
authors.forename: Astrid E
authors.initials: AE
authors.lastname: Greijer
authors.forename: Sandra A W M
authors.initials: SA
authors.lastname: Verkuijlen
authors.forename: Hedy
authors.initials: H
authors.lastname: Juwana
authors.forename: Sabine
authors.initials: S
authors.lastname: Fleig
authors.forename: Lisnawati
authors.initials: L
authors.lastname: Rachmadi
authors.forename: Octavia
authors.initials: O
authors.lastname: Malik
authors.forename: A N
authors.initials: AN
authors.lastname: Kurniawan
authors.forename: Averdi
authors.initials: A
authors.lastname: Roezin
authors.forename: Soehartati
authors.initials: S
authors.lastname: Gondhowiardjo
authors.forename: Djumhana
authors.initials: D
authors.lastname: Atmakusumah
authors.forename: Servi J C
authors.initials: SJ
authors.lastname: Stevens
authors.forename: Bambang
authors.initials: B
authors.lastname: Hermani
authors.forename: I Bing
authors.initials: IB
authors.lastname: Tan
authors.forename: Jaap M
authors.initials: JM
authors.lastname: Middeldorp
mesh_terms: D000293:Adolescent; D000328:Adult; D002277:Carcinoma; D059248:Chemoradiotherapy; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000097:blood* / Q000235:genetics; D042241:Early Diagnosis; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000187:drug effects / Q000235:genetics* / Q000528:radiation effects; D006801:Humans; D008297:Male; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D009305:Nasopharynx / Q000187:drug effects / Q000528:radiation effects / Q000821:virology*; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects / Q000528:radiation effects; D055815:Young Adult
chemical_list: D004279:DNA, Viral