title: Prospective study of tailoring whole-body dual-modality [18F]fluorodeoxyglucose positron emission tomography/computed tomography with plasma Epstein-Barr virus DNA for detecting distant metastasis in endemic nasopharyngeal carcinoma at initial staging.
abstract: OBJECTIVE
  To evaluate which patients with nasopharyngeal carcinoma (NPC) obtained the greatest benefits from the detection of distant metastasis with [(18)F]fluorodeoxyglucose positron emission tomography and computed tomography (PET/CT) combined with plasma Epstein-Barr virus (EBV) DNA levels.
  
  
  METHODS
  Consecutive patients with NPC were prospectively enrolled. PET/CT, conventional work-up (CWU), and quantification of plasma EBV DNA were performed before treatment. The accuracy of these strategies for distant metastases was assessed. The costs of the diagnostic strategies were compared.
  
  
  RESULTS
  Eighty-six (14.8%) of the 583 eligible patients were found to have distant metastases; 71 patients (82.6%) by PET/CT and 31 patients (36.0%) by CWU. In the multivariable analysis, advanced N stage (odds ratio, 2.689; 95% CI, 1.894 to 3.818) and pretreatment EBV DNA level (odds ratio, 3.344; 95% CI, 1.825 to 6.126) were significant risk factors for distant metastases. PET/CT was not superior to CWU for detecting distant metastases in very low-risk patients (N0-1 with EBV DNA < 4,000 copies/mL; P = .062), but was superior for the low-risk patients (N0-1 with EBV DNA ≥ 4,000 copies/mL and N2-3 with EBV DNA < 4,000 copies/mL; P = .039) and intermediate-risk patients (N2-3 disease with EBV DNA ≥ 4,000 copies/mL; P < .001). The corresponding patient management changes based on PET/CT were 2.9%, 6.3%, and 16.5%, respectively. The costs per true-positive case detected by PET/CT among these groups were ¥324,138 (≈$47,458), ¥96,907 (≈$14,188), and ¥34,182 (≈$5,005), respectively.
  
  
  CONCLUSIONS
  PET/CT detects more distant metastases than conventional staging in patients with NPC. The largest benefit in terms of cost and patient management was observed in the subgroup with N2-3 disease and EBV DNA ≥ 4,000 copies/mL.
authors.affiliation: State Key Laboratory of Oncology in South China and Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
authors.forename: Lin-Quan
authors.initials: LQ
authors.lastname: Tang
authors.forename: Qiu-Yan
authors.initials: QY
authors.lastname: Chen
authors.forename: Wei
authors.initials: W
authors.lastname: Fan
authors.forename: Huai
authors.initials: H
authors.lastname: Liu
authors.forename: Lu
authors.initials: L
authors.lastname: Zhang
authors.forename: Ling
authors.initials: L
authors.lastname: Guo
authors.forename: Dong-Hua
authors.initials: DH
authors.lastname: Luo
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Huang
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Lin
authors.forename: Yun-Xian
authors.initials: YX
authors.lastname: Mo
authors.forename: Li-Zhi
authors.initials: LZ
authors.lastname: Liu
authors.forename: Hao-Yuan
authors.initials: HY
authors.lastname: Mo
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.forename: Ru-Hai
authors.initials: RH
authors.lastname: Zou
authors.forename: Yun
authors.initials: Y
authors.lastname: Cao
authors.forename: Yan-Qun
authors.initials: YQ
authors.lastname: Xiang
authors.forename: Fang
authors.initials: F
authors.lastname: Qiu
authors.forename: Rui
authors.initials: R
authors.lastname: Sun
authors.forename: Ming-Yuan
authors.initials: MY
authors.lastname: Chen
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Hua
authors.forename: Xing
authors.initials: X
authors.lastname: Lv
authors.forename: Lin
authors.initials: L
authors.lastname: Wang
authors.forename: Chong
authors.initials: C
authors.lastname: Zhao
authors.forename: Xiang
authors.initials: X
authors.lastname: Guo
authors.forename: Ka-Jia
authors.initials: KJ
authors.lastname: Cao
authors.forename: Chao-Nan
authors.initials: CN
authors.lastname: Qian
authors.forename: Mu-Sheng
authors.initials: MS
authors.lastname: Zeng
authors.forename: Hai-Qiang
authors.initials: HQ
authors.lastname: Mai
mesh_terms: D002277:Carcinoma; D004279:DNA, Viral / Q000097:blood*; D020031:Epstein-Barr Virus Infections / Q000097:blood* / Q000000981:diagnostic imaging / Q000235:genetics; D005260:Female; D019788:Fluorodeoxyglucose F18; D004854:Herpesvirus 4, Human / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000473:pathology / Q000821:virology*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
chemical_list: D004279:DNA, Viral; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18