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King AD, Ai QYH, Lam WKJ, Tse IOL, So TY, Wong LM, Tsang JYM, Leung HS, Zee BCY, Hui EP, Ma BBY, Vlantis AC, van Hasselt AC, Chan ATC, Woo JKS, Chan KCA. Early detection of nasopharyngeal carcinoma: performance of a short contrast-free screening magnetic resonance imaging. J Natl Cancer Inst 2024; 116:665-672. [PMID: 38171488 DOI: 10.1093/jnci/djad260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Although contrast-enhanced magnetic resonance imaging (MRI) detects early-stage nasopharyngeal carcinoma (NPC) not detected by endoscopic-guided biopsy (EGB), a short contrast-free screening MRI would be desirable for NPC screening programs. This study evaluated a screening MRI in a plasma Epstein-Barr virus (EBV)-DNA NPC screening program. METHODS EBV-DNA-screen-positive patients underwent endoscopy, and endoscopy-positive patients underwent EGB. EGB was negative if the biopsy was negative or was not performed. Patients also underwent a screening MRI. Diagnostic performance was based on histologic confirmation of NPC in the initial study or during a follow-up period of at least 2 years. RESULTS The study prospectively recruited 354 patients for MRI and endoscopy; 40/354 (11.3%) endoscopy-positive patients underwent EGB. Eighteen had NPC (5.1%), and 336 without NPC (94.9%) were followed up for a median of 44.8 months. MRI detected additional NPCs in 3/18 (16.7%) endoscopy-negative and 2/18 (11.1%) EGB-negative patients (stage I/II, n = 4; stage III, n = 1). None of the 24 EGB-negative patients who were MRI-negative had NPC. MRI missed NPC in 2/18 (11.1%), one of which was also endoscopy-negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI, endoscopy, and EGB were 88.9%, 91.1%, 34.8%, 99.4%, and 91.0%; 77.8%, 92.3%, 35.0%, 98.7%, and 91.5%; and 66.7%, 92.3%, 31.6%, 98.1%, and 91.0%, respectively. CONCLUSION A quick contrast-free screening MRI complements endoscopy in NPC screening programs. In EBV-screen-positive patients, MRI enables early detection of NPC that is endoscopically occult or negative on EGB and increases confidence that NPC has not been missed.
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Affiliation(s)
- Ann D King
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Qi Yong H Ai
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - W K Jacky Lam
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Irene O L Tse
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tiffany Y So
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lun M Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jayden Yip Man Tsang
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Sang Leung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Benny C Y Zee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Brigette B Y Ma
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alexander C Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Andrew C van Hasselt
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - John K S Woo
- Department of Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K C Allen Chan
- Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
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2
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Chan KCA, Lam WKJ, King A, Lin VS, Lee PPH, Zee BCY, Chan SL, Tse IOL, Tsang AFC, Li MZJ, Jiang P, Ai QYH, Poon DMC, Au KH, Hui EP, Ma BBY, Van Hasselt AC, Chan ATC, Woo JKS, Lo YMD. Plasma Epstein-Barr Virus DNA and Risk of Future Nasopharyngeal Cancer. NEJM Evid 2023; 2:EVIDoa2200309. [PMID: 38320164 DOI: 10.1056/evidoa2200309] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
EBV DNA Rescreening StudyPatients who had participated in a previous plasma Epstein-Barr virus (EBV) DNA screening study were rescreened. Of the 17,838 rescreened patients, 423 had persistently detectable plasma EBV DNA; 24 of these patients developed nasopharyngeal carcinoma. Sixty-seven percent of them received a diagnosis of early-stage disease and had increased progression-free survival compared with historical controls.
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Affiliation(s)
- K C Allen Chan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
| | - W K Jacky Lam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Ann King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Vivien S Lin
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
| | - Patrick P H Lee
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
| | - Benny C Y Zee
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Stephen L Chan
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Irene O L Tse
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
| | - Amy F C Tsang
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
| | - Maggie Z J Li
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
| | - Peiyong Jiang
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
| | - Qi Yong H Ai
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Darren M C Poon
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - K H Au
- Department of Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Edwin P Hui
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Brigette B Y Ma
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Andrew C Van Hasselt
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Anthony T C Chan
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - John K S Woo
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Y M Dennis Lo
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- State Key Laboratory of Translational Oncology, Sir Y.K. Pao Centre for Cancer, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
- Centre for Novostics, The Chinese University of Hong Kong, Hong Kong Science and Technology Park, Pak Shek Kok, New Territories, Hong Kong SAR, China
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3
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Wang G, Lam WKJ, Ling L, Ma MJL, Ramakrishnan S, Chan DCT, Lee WS, Cheng SH, Chan RWY, Yu SCY, Tse IOL, Wong WT, Jiang P, Chiu RWK, Allen Chan KC, Lo YMD. Fragment Ends of Circulating Microbial DNA as Signatures for Pathogen Detection in Sepsis. Clin Chem 2023; 69:189-201. [PMID: 36576350 DOI: 10.1093/clinchem/hvac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/13/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nuclear-derived cell-free DNA (cfDNA) molecules in blood plasma are nonrandomly fragmented, bearing a wealth of information related to tissues of origin. DNASE1L3 (deoxyribonuclease 1 like 3) is an important player in shaping the fragmentation of nuclear-derived cfDNA molecules, preferentially generating molecules with 5 CC dinucleotide termini (i.e., 5 CC-end motif). However, the fragment end properties of microbial cfDNA and its clinical implication remain to be explored. METHODS We performed end motif analysis on microbial cfDNA fragments in plasma samples from patients with sepsis. A sequence context-based normalization method was used to minimize the potential biases for end motif analysis. RESULTS The end motif profiles of microbial cfDNA appeared to resemble that of nuclear cfDNA (Spearman correlation coefficient: 0.82, P value 0.001). The CC-end motif was the most preferred end motif in microbial cfDNA, suggesting that DNASE1L3 might also play a role in the fragmentation of microbe-derived cfDNA in plasma. Of note, differential end motifs were present between microbial cfDNA originating from infection-causing pathogens (enriched at the CC-end) and contaminating microbial DNA potentially derived from reagents or the environment (nearly random). The use of fragment end signatures allowed differentiation between confirmed pathogens and contaminating microbes, with an area under the receiver operating characteristic curve of 0.99. The performance appeared to be superior to conventional analysis based on microbial cfDNA abundance alone. CONCLUSIONS The use of fragmentomic features could facilitate the differentiation of underlying contaminating microbes from true pathogens in sepsis. This work demonstrates the potential usefulness of microbial cfDNA fragmentomics in metagenomics analysis.
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Affiliation(s)
- Guangya Wang
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - W K Jacky Lam
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Mary-Jane L Ma
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Saravanan Ramakrishnan
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Don C T Chan
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Wing-Shan Lee
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Suk Hang Cheng
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Rebecca W Y Chan
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Stephanie C Y Yu
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Irene O L Tse
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Wai Tat Wong
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Peiyong Jiang
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Rossa W K Chiu
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - K C Allen Chan
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - Y M Dennis Lo
- Centre for Novostics, Hong Kong Science Park, Pak Shek Kok, New Territories, Hong Kong SAR, China.,Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.,Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
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4
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King AD, Woo JKS, Ai QY, Mo FKF, So TY, Lam WKJ, Tse IOL, Vlantis AC, Yip KWN, Hui EP, Ma BBY, Chiu RWK, Chan ATC, Lo YMD, Chan KCA. Early Detection of Cancer: Evaluation of MR Imaging Grading Systems in Patients with Suspected Nasopharyngeal Carcinoma. AJNR Am J Neuroradiol 2020; 41:515-521. [PMID: 32184223 DOI: 10.3174/ajnr.a6444] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/14/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE We evaluated modifications to our contrast-enhanced MR imaging grading system for symptomatic patients with suspected nasopharyngeal carcinoma, aimed at improving discrimination of early-stage cancer and benign hyperplasia. We evaluated a second non-contrast-enhanced MR imaging grading system for asymptomatic patients from nasopharyngeal carcinoma plasma screening programs. MATERIALS AND METHODS Dedicated nasopharyngeal MR imaging before (plain scan system) and after intravenous contrast administration (current and modified systems) was reviewed in patients from a nasopharyngeal carcinoma-endemic region, comprising 383 patients with suspected disease without nasopharyngeal carcinoma and 383 patients with nasopharyngeal carcinoma. The modified and plain scan systems refined primary tumor criteria, added a nodal assessment, and expanded the system from 4 to 5 grades. The overall combined sensitivity and specificity of the 3 systems were compared using the extended McNemar test (a χ2 value [Formula: see text]> 5.99 indicates significance). RESULTS The current, modified, and plain scan MR imaging systems yielded sensitivities of 99.74%, 97.91%, and 97.65%, respectively, and specificities of 63.45%, 89.56% and 86.42%, respectively. The modified system yielded significantly better performance than the current ([Formula: see text] = 122) and plain scan ([Formula: see text] = 6.1) systems. The percentages of patients with nasopharyngeal carcinoma in grades 1-2, grade 3, and grades 4-5 for the modified and plain scan MR imaging systems were 0.42% and 0.44%; 6.31% and 6.96%; and 90.36% and 87.79%, respectively. No additional cancers were detected after contrast administration in cases of a plain scan graded 1-2. CONCLUSIONS We propose a modified MR imaging grading system that improves diagnostic performance for nasopharyngeal carcinoma detection. Contrast was not valuable for low MR imaging grades, and the plain scan shows potential for use in screening programs.
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Affiliation(s)
- A D King
- From the Departments of Imaging and Interventional Radiology (A.D.K., Q.Y.A., T.Y.S., K.W.N.Y.)
| | - J K S Woo
- Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
| | - Q-Y Ai
- Clinical Oncology (F.K.F.M., E.P.H., B.B.Y.M., A.T.C.C.)
| | - F K F Mo
- Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - T Y So
- From the Departments of Imaging and Interventional Radiology (A.D.K., Q.Y.A., T.Y.S., K.W.N.Y.)
| | - W K J Lam
- Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Hong Kong SAR, China
| | - I O L Tse
- Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A C Vlantis
- Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., A.C.V.)
| | - K W N Yip
- From the Departments of Imaging and Interventional Radiology (A.D.K., Q.Y.A., T.Y.S., K.W.N.Y.)
| | - E P Hui
- Clinical Oncology (F.K.F.M., E.P.H., B.B.Y.M., A.T.C.C.).,Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - B B Y Ma
- Clinical Oncology (F.K.F.M., E.P.H., B.B.Y.M., A.T.C.C.).,Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - R W K Chiu
- Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A T C Chan
- Clinical Oncology (F.K.F.M., E.P.H., B.B.Y.M., A.T.C.C.).,Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Y M D Lo
- Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K C A Chan
- Chemical Pathology (W.K.J.L., I.O.L.T., R.W.K.C., Y.M.D.L., K.C.A.C.).,Li Ka Shing Institute of Health Sciences (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.,State Key Laboratory of Translational Oncology (F.K.F.M., W.K.J.L., I.O.L.T., E.P.H., B.B.Y.M., R.W.K.C., A.T.C.C., Y.M.D.L., K.C.A.C.), The Chinese University of Hong Kong, Hong Kong SAR, China
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5
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King AD, Woo JKS, Ai QY, Chan JSM, Lam WKJ, Tse IOL, Bhatia KS, Zee BCY, Hui EP, Ma BBY, Chiu RWK, van Hasselt AC, Chan ATC, Lo YMD, Chan KCA. Complementary roles of MRI and endoscopic examination in the early detection of nasopharyngeal carcinoma. Ann Oncol 2020; 30:977-982. [PMID: 30912815 DOI: 10.1093/annonc/mdz106] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early-stage nasopharyngeal carcinoma (NPC) evades detection when the primary tumor is hidden from view on endoscopic examination. Therefore, in a prospective study of subjects being screened for NPC using plasma Epstein-Barr virus (EBV) DNA, we conducted a study to investigate whether magnetic resonance imaging (MRI) could detect endoscopically occult NPC. PATIENTS AND METHODS Participants with persistently positive EBV DNA underwent endoscopic examination and biopsy when suspicious for NPC, followed by MRI blinded to the endoscopic findings. Participants with a negative endoscopic examination and positive MRI were recalled for biopsy or surveillance. Diagnostic performance was assessed by calculating sensitivity, specificity and accuracy, based on the histologic confirmation of NPC in the initial study or in a follow-up period of at least two years. RESULTS Endoscopic examination and MRI were performed on 275 participants, 34 had NPC, 2 had other cancers and 239 without cancer were followed-up for a median of 36 months (24-60 months). Sensitivity, specificity and accuracy were 76.5%, 97.5% and 94.9%, respectively, for endoscopic examination and 91.2%, 97.5% and 96.7%, respectively, for MRI. NPC was detected only by endoscopic examination in 1/34 (2.9%) participants (a participant with stage I disease), and only by MRI in 6/34 (17.6%) participants (stage I = 4, II = 1, III = 1), two of whom had stage I disease and follow-up showing slow growth on MRI but no change on endoscopic examination for 36 months. CONCLUSION MRI has a complementary role to play in NPC detection and can enable the earlier detection of endoscopically occult NPC.
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Affiliation(s)
- A D King
- Departments of Imaging and Interventional Radiology.
| | - J K S Woo
- Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - Q Y Ai
- Departments of Imaging and Interventional Radiology
| | - J S M Chan
- Departments of Imaging and Interventional Radiology
| | - W K J Lam
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - I O L Tse
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K S Bhatia
- Department of Imaging, St Mary's Hospital, Imperial College Healthcare, National Health Service Trust, London, UK
| | - B C Y Zee
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR
| | - E P Hui
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - B B Y Ma
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - R W K Chiu
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - A C van Hasselt
- Otorhinolaryngology, Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
| | - A T C Chan
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Y M D Lo
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - K C A Chan
- Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; Department of Chemical Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR; State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Hong Kong SAR, China
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6
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Ai QY, King AD, So TY, Lam WKJ, Mo FKF, Tse IOL, Woo JKS, Chan KCA. MRI of benign hyperplasia in the nasopharynx: is there an association with Epstein-Barr virus? Clin Radiol 2020; 75:711.e13-711.e18. [PMID: 32571521 DOI: 10.1016/j.crad.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
AIM To evaluate whether there is an association between persistently positive plasma Epstein-Barr virus (EBV) DNA and the presence and the change in benign hyperplasia. MATERIALS AND METHODS One hundred and seventeen participants with positive-plasma EBV-DNA, but without NPC from previous nasopharyngeal carcinoma (NPC) screening, underwent follow-up magnetic resonance imaging (MRI) and plasma EBV-DNA after 2 years. Logistic regression was used to analyse associations between MRI (benign hyperplasia on the follow-up MRI and change from 2 years earlier), and plasma EBV-DNA, smoking, and age. RESULTS At follow-up, EBV-DNA positivity and smoking were independent parameters for the presence of benign hyperplasia (p=0.027 and 0.023 respectively). Compared with participants in whom EBV-DNA became negative (n=44/117 37.6%), those in whom EBV-DNA remained positive (n=73/117 62.4%) had a greater risk of benign hyperplasia developing (previous MRI normal), being stable or processing (52/73 71.2% versus 18/44 40.9%; p=0.001). CONCLUSION These results suggest a potential link between benign hyperplasia on MRI and the EBV. As EBV contributes to NPC oncogenesis, future MRI research is warranted to determine if persistent benign hyperplasia is a risk marker for development of NPC.
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Affiliation(s)
- Q-Y Ai
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - A D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
| | - T Y So
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - W K J Lam
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - F K F Mo
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - I O L Tse
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - J K S Woo
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - K C A Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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7
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Chan KCA, Woo JKS, King A, Zee BCY, Lam WKJ, Chan SL, Chu SWI, Mak C, Tse IOL, Leung SYM, Chan G, Hui EP, Ma BBY, Chiu RWK, Leung SF, van Hasselt AC, Chan ATC, Lo YMD. Analysis of Plasma Epstein-Barr Virus DNA to Screen for Nasopharyngeal Cancer. N Engl J Med 2017; 377:513-522. [PMID: 28792880 DOI: 10.1056/nejmoa1701717] [Citation(s) in RCA: 432] [Impact Index Per Article: 61.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Circulating cell-free Epstein-Barr virus (EBV) DNA is a biomarker for nasopharyngeal carcinoma. We conducted a prospective study to investigate whether EBV DNA in plasma samples would be useful to screen for early nasopharyngeal carcinoma in asymptomatic persons. METHODS We analyzed EBV DNA in plasma specimens to screen participants who did not have symptoms of nasopharyngeal carcinoma. Participants with initially positive results were retested approximately 4 weeks later, and those with persistently positive EBV DNA in plasma underwent nasal endoscopic examination and magnetic resonance imaging (MRI). RESULTS A total of 20,174 participants underwent screening. EBV DNA was detectable in plasma samples obtained from 1112 participants (5.5%), and 309 (1.5% of all participants and 27.8% of those who initially tested positive) had persistently positive results on the repeated sample. Among these 309 participants, 300 underwent endoscopic examination, and 275 underwent both endoscopic examination and MRI; of these participants, 34 had nasopharyngeal carcinoma. A significantly higher proportion of participants with nasopharyngeal carcinoma that was identified by screening had stage I or II disease than in a historical cohort (71% vs. 20%, P<0.001 by the chi-square test) and had superior 3-year progression-free survival (97% vs. 70%; hazard ratio, 0.10; 95% confidence interval, 0.05 to 0.18). Nine participants declined to undergo further testing, and 1 of them presented with advanced nasopharyngeal carcinoma 32 months after enrollment. Nasopharyngeal carcinoma developed in only 1 participant with negative EBV DNA in plasma samples within 1 year after testing. The sensitivity and specificity of EBV DNA in plasma samples in screening for nasopharyngeal carcinoma were 97.1% and 98.6%, respectively. CONCLUSIONS Analysis of EBV DNA in plasma samples was useful in screening for early asymptomatic nasopharyngeal carcinoma. Nasopharyngeal carcinoma was detected significantly earlier and outcomes were better in participants who were identified by screening than in those in a historical cohort. (Funded by the Kadoorie Charitable Foundation and the Research Grants Council of the Hong Kong government; ClinicalTrials.gov number, NCT02063399 .).
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Affiliation(s)
- K C Allen Chan
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - John K S Woo
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Ann King
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Benny C Y Zee
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - W K Jacky Lam
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Stephen L Chan
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Sam W I Chu
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Constance Mak
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Irene O L Tse
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Samantha Y M Leung
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Gloria Chan
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Edwin P Hui
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Brigette B Y Ma
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Rossa W K Chiu
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Sing-Fai Leung
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Andrew C van Hasselt
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Anthony T C Chan
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
| | - Y M Dennis Lo
- From the Li Ka Shing Institute of Health Sciences (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), the Department of Chemical Pathology (K.C.A.C., W.K.J.L., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., R.W.K.C., Y.M.D.L.), State Key Laboratory of Oncology in South China, Sir Y.K. Pao Centre for Cancer (K.C.A.C., W.K.J.L., S.L.C., S.W.I.C., C.M., I.O.L.T., S.Y.M.L., G.C., E.P.H., B.B.Y.M., R.W.K.C., S.-F.L., A.T.C.C., Y.M.D.L.), Department of Otorhinolaryngology, Head and Neck Surgery (J.K.S.W., W.K.J.L., A.C.H.), Department of Imaging and Interventional Radiology (A.K.), Jockey Club School of Public Health and Primary Care (B.C.Y.Z.), and Department of Clinical Oncology (S.L.C., E.P.H., B.B.Y.M., S.-F.L., A.T.C.C.), Chinese University of Hong Kong, Prince of Wales Hospital - all in Hong Kong
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