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JNCI Journal of the National Cancer Institute 1999 91(9):796-800; doi:10.1093/jnci/91.9.796
© 1999 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 91, No. 9, 796-800, May 5, 1999
© 1999 Oxford University Press

REPORTS

Nasopharyngeal Brush Biopsies and Detection of Nasopharyngeal Cancer in a High-Risk Population

Cathryn E. Tune, Per-Gunnar Liavaag, Jeremy L. Freeman, Michiel W. M. van den Brekel, Thomas Shpitzer, Jeroen D. F. Kerrebijn, David Payne, Jonathan C. Irish, Raymond Ng, Roy K. Cheung, Hans-Michael Dosch

Affiliations of authors: C. E. Tune, P.-G. Liavaag, R. K. Cheung, H.-M. Dosch, Division of Immunology and Cancer Research, Hospital for Sick Children, Toronto, ON, Canada; J. L. Freeman, M. W. M. van den Brekel, T. Shpitzer, J. D. F. Kerrebijn, Department of Otolaryngology, Mount Sinai Hospital, Toronto; D. Payne, Division of Radiation Oncology, Princess Margaret Hospital, Toronto; J. C. Irish, Department of Otolaryngology, Toronto Hospital-General Division; R. Ng, Centenary Health Center, Scarborough, ON.

Correspondence to: Professor Hans-Michael Dosch, Division of Immunology and Cancer Research, Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada M5G 1X8 (e-mail: hmdosch{at}sickkids.on.ca).

BACKGROUND: Nasopharyngeal carcinoma (NPC) is an important tumor in many countries. Ethnic and regional factors strongly influence disease risk. NPC is usually diagnosed late in disease development, and 10-year survival rates are as low as 10%. Epstein-Barr virus (EBV), a possibly causative agent, is present in all cells of essentially all undifferentiated NPCs. We wished to determine the following: 1) whether an ambulatory nasopharyngeal brush biopsy could provide sufficient tumor cell DNA for the detection of EBV and 2) whether the detection of EBV in this locale reflects the presence of tumor cells or simply EBV carrier status. METHODS: We collected nasopharyngeal tissue via ambulatory brush biopsies from 21 patients with newly diagnosed NPC and from 157 subjects with other otolaryngologic complaints. The majority of study subjects were from high-risk populations. Sample DNA was analyzed for the presence of EBV genomic sequences by use of the polymerase chain reaction (PCR). RESULTS: Ninety-six percent of samples yielded sufficient DNA for PCR amplification. Nineteen of 21 patients with NPC brushed positive for EBV DNA, while all but two (1.3%) of 149 informative control subjects were negative for EBV (two-sided P<.0001). One of the EBV-positive control subjects had an EBV-positive inverted sinonasal papilloma; the other EBV-positive control subject exhibited no overt clinical disease. CONCLUSION: Demonstration of EBV DNA in nasopharyngeal brush biopsy specimens detects NPC with a sensitivity of at least 90% (95% confidence interval = 89.63%-91.32%) and a specificity of approximately 99% (95% confidence interval = 98.64%-98.68%). This technique merits further testing as a possible ambulatory screening strategy in high-risk populations.


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