淋巴结EBV-DNA检测在鼻咽癌颈淋巴结转移中的诊断价值

Diagnostic value of lymph node EBV-DNA detection in cervical lymph node metastasis of nasopharyn-geal carcinoma

目的 探讨淋巴结细针抽吸活检（FNA）洗脱液EB病毒（EBV）-DNA浓度测定对鼻咽癌颈部淋巴结转移的诊断价值。方法 选取2016年8月至12月在中山大学肿瘤防治中心病理确诊为鼻咽癌的患者36例及非EBV相关的其他肿瘤患者9例，所有患者行头颈部MRI、血清和颈部淋巴结FNA洗脱液EBVDNA检测。结果 淋巴结EBVDNA检测中位浓度（1.39×105 copies/ml）高于血清EBVDNV检测中位浓度（2.00×103 copies/ml），差异有统计学意义（χ2=16.723，P=0.004）。淋巴结FNA洗脱液EBVDNA检测的敏感性86.2%（25/29）、特异性71.4%（10/14）、准确率81.4%（35/43），优于MRI的敏感性72.4%（21/29）、特异性50.0%（7/14）、准确率65.1%（28/43）与血清EBVDNA检测的敏感性55.2%（16/29）、特异性71.4%（10/14）、准确率60.5%（26/43）。对颈Ⅰb区淋巴结的诊断计算曲线下面积（AUC），FNA洗脱液EBVDNA检测的AUC（0.688）大于MRI（0.583），差异有统计学意义（Z=2.476，P=0.008）。非EBV相关性的其他肿瘤患者淋巴结FNA洗脱液中EBVDNA拷贝数为0 copy/ml。结论 FNA洗脱液EBVDNA检测可提高鼻咽癌颈部淋巴结转移诊断的敏感性，对Ⅰb区淋巴结靶区勾画具有指导意义。

Objective To evaluate the diagnostic value of lymph node fineneedle aspiration （FNA） EpsteinBarr virus （EBV）-DNA concentration detection in nasopharyngeal carcinoma （NPC） cervical lymph node metastasis. MethodsFrom August to December 2016, 36 cases of NPC and 9 cases of other tumors （not correlated with EBV infection） were enrolled in this study at the Sun Yatsen University Cancer Center. All patients received magnetic resonance images （MRI）, plasma and cervical lymph node FNA EBVDNA detection. ResultsThe median concentration of EBVDNA in FNA fluid （1.39×105 copies/ml） in cervical lymph node metastasis was significantly higher than that in plasma （2.00×103 copies/ml）, with a significant difference （χ2=16.723, P=0.004）. The diagnosis sensitivity, specificity, accuracy of the lymph node FNA fluid of EBVDNA were 86.2% （25/29）, 71.4% （10/14） and 81.4% （35/43） respectively, which were better than those of MRI [72.4% （21/29）, 50.0% （7/14） and 65.1% （28/43） respectively] and plasma EBVDNA [55.2% （16/29）, 71.4% （10/14） and 60.5% （26/43） respectively]. The area under the curve （AUC） of level Ⅰb cervical lymph node metastasis was calculated, and FNA fluid EBVDNA （AUC=0.688） was better than MRI （AUC=0.583）, with a significant difference （Z=2.476, P=0.008）. The EBVDNA concentration in FNA fluid in cervical lymph node metastasis of patients with other tumors （no correlated with EBV infection） was 0 copy/ml. ConclusionFNA fluid EBVDNA may improve the diagnostic sensitivity of cervical lymph node metastasis in nasopharyngeal carcinoma, and help to explore the clinical target volume neck nodes at level Ⅰb cervical lymph node in radiotherapy.