Although Epstein-Barr virus (EBV) IgA serology has been established as an e
ffective marker for nasopharyngeal carcinoma (NPC), it remains unclear how
useful or cost-effective it is as a screening test. This article is aimed a
t establishing how these tests could be used most effectively in the diagno
sis of NPC in an otolaryngology outpatient clinic. A total of 111 consecuti
ve patients with NPC and an equal number of control subjects were studied.
Forty-seven patients with NPC had early (AJCC stages 1 and 2) and 64 had ad
vanced (stages 3 and 4) disease. A positive early antigen (EA) serology res
ult was found in 81.2% of NPC patients and in none of the controls. Negativ
e EA and viral capsid antigen (VCA) serology results were present in 2.7% o
f NPC patients and in 46.8% of controls. Negative EA and positive VCA serol
ogy results were found in 30.0% of NPC patients with early disease, 7.8% of
NPC patients with advanced disease, and 53.2% of controls. Given its high
specificity, serology for EA is recommended as a clinically useful screenin
g test. Serology for VCA, although highly sensitive, has an unacceptably hi
gh false-positive rate, and its cost-effectiveness as a universal screening
test is questionable.