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Outcome of patients with positive Epstein-Barr virus serologic status in the absence of nasopharyngeal carcinoma in Hong Kong.

OBJECTIVE
To evaluate the current clinical practice of follow-up and the outcomes of patients with raised Epstein-Barr virus (EBV) antibody levels but without pathological evidence of nasopharyngeal carcinoma (NPC) for a possible risk of developing NPC in the future.


DESIGN
Retrospective review of prospectively collected database.


SETTING
Tertiary referral otorhinolaryngology center.


PATIENTS
The study population comprised 66 patients (27 male and 39 female; median age, 43.5 [range, 9-78] years) who presented in 1997 with a positive EBV IgA viral capsid antigen titer but a negative nasopharyngeal biopsy result.


MAIN OUTCOME MEASURES
The detection of NPC and EBV seroconversion rate.


RESULTS
Of the 66 patients studied, 14 had a positive family history of NPC. Fourteen patients (27%) were excluded because of loss of contact or refusal of follow-up. The median follow-up period of the remaining 52 patients was 54.5 months (range, 12-64 months). Of these 52 patients, 39 (75%) had initial nasendoscopic finding described as completely normal. During the follow-up period, NPC was diagnosed in 1 patient (2%) 18 months after first biopsy. The initial nasendoscopy and histological findings in this patient were normal despite the patient having a raised EBV IgA VCA titer of 1:640. Overall, the EBV serologic status of 36 patients (69%) reverted to normal within the studied period (median interval of 54.5 [range, 12-64] months).


CONCLUSIONS
In the median follow-up period of 54.5 months, only 1 patient (2%) developed NPC. A significant proportion of the patients seroconverted back to normal, none of whom developed NPC.