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Lymph-node Epstein–Barr virus concentration in diagnosing cervical lymph-node metastasis in nasopharyngeal carcinoma

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A Correction to this article was published on 10 November 2020

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Abstract

Purpose

Cervical lymph-node (CLN) metastasis commonly occurs in patients with nasopharyngeal carcinoma (NPC) metastasis. The presence of Epstein–Barr virus (EBV) genomes in neck lymph nodes may diagnose CLN. This research was designed to appraise the diagnostic value of EBV concentration for cervical lymph nodes in NPC.

Methods

Two hundred and fifty-three NPC patients with 276 CLNs were enrolled. MRI was performed to detect CLN metastasis, and plasma EBV concentration was measured by quantitative PCR before treatment. Ultrasonography (US) and US-FNA were subsequently performed in the suspicious lymph nodes. Fifteen patients (22 lymph nodes) underwent fine-needle aspiration cytology (FNAC), and the remaining 242 patients (254 lymph nodes) underwent core needle biopsy (CNB) for CLNs at the clinician’s demand. The aspiration needle was rinsed with 1 ml of normal saline for EBV detection. The method of lymph-node EBV measurement was consistent with that for plasma. The MRI results and EBV concentrations in plasma and lymph nodes were recorded and analyzed. Plasma EBV concentrations ≥ 4000 copies/ml were regarded as positive.

Results

CLN-EBV concentrations ≥ 787.5 copies/ml were regarded as positive according to receiver-operating characteristic curve analysis. The AUC of the EBV (0.925) concentration in CLN metastasis was significantly larger than the AUC of MRI (0.714) (P < 0.001). The sensitivity and specificity were 94.09% and 48.72% for MRI in lymph-node metastasis and 95.36% (P > 0.05) and 84.62% (P < 0.01) for EBV DNA in CLN metastasis, respectively. The sensitivity and specificity of EBV in plasma were 77.2% and 71.8%, respectively. The diagnostic specificity and AUC of EBV in CLNs were higher than those of MRI and plasma EBV (P < 0.005).

Conclusions

Ultrasound-guided CLN FNA to obtain EBV concentrations may provide a new method to diagnose CLN metastasis with high sensitivity and specificity.

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Change history

  • 10 November 2020

    In the original publication of the article, the affiliation of the author ���Can Huang��� was published incorrectly.

Abbreviations

CLN:

Cervical lymph node

NPC:

Nasopharyngeal carcinoma

EBV:

Epstein-Barr virus

FNAC:

Fine-needle aspiration cytology

FNA:

Fine-needle aspiration

PCR:

Polymerase chain reaction

IMRT:

Intensity-modulated radiotherapy

AJCC:

American Joint Committee on Cancer

CT:

Computed tomography

HIV:

Human immuno-deficiency virus

MRI:

Magnetic resonance imaging

FSE:

Fast spin-echo

T1WT:

T1-weighted imaging

T2WT:

T1-weighted imaging

RPN:

Retropharyngeal lymph nodes

CI:

Confidence interval

ROC:

Receiver-operating characteristic

NPV:

Negative predictive value

PPV:

Positive predictive value

AUC:

The area under the ROC curve

ROC:

Receiver-operating characteristic

CNB:

Core needle biopsy

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Funding

This work was supported by the Science and Technology Planning Project of Guangdong Province, China (No. 2017A050506020).

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Authors and Affiliations

  1. State Key Laboratory of Oncology in South China, Department of Ultrasound, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People’s Republic of China

    HuiFang Li, Can Huang, Chuan Peng & Ruhai Zou

  2. Kanghua Hospital, Dongguan, 523039, Guangdong, People’s Republic of China

    Can Huang

  3. State Key Laboratory of Oncology in South China, Department of Nasopharyngeal Carcinoma, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People’s Republic of China

    Qiuyan Chen, Mingyuan Chen & Haiqiang Mai

  4. State Key Laboratory of Oncology in South China, Department of Radiology, Collaborative Innovation Center of Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, People’s Republic of China

    Rong Zhang & Jingxian Shen

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  1. HuiFang Li
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  2. Can Huang
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  3. Qiuyan Chen
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Contributions

HM and RHZ had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. HL and CH contributed equally to the work and are co-first authors. RHZ and HM: Study concept and design. HL and CH: Study concept and design. HL: Statistical analysis. HL and CH: Manuscript editing. All authors read and approved the final manuscript.

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Correspondence to Haiqiang Mai or Ruhai Zou.

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This study was approved by the institutional review board (B2018-023) and all patients was provided informed consent.

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Li, H., Huang, C., Chen, Q. et al. Lymph-node Epstein–Barr virus concentration in diagnosing cervical lymph-node metastasis in nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 277, 2513–2520 (2020). https://doi.org/10.1007/s00405-020-05937-5

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