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Patients with malignant lesions in whom type 2 or type 3 nasopharyngeal carcinoma is suspected (eg, patients with metastases to the cervical lymph nodes from an unknown primary source)
Infection with Epstein-Barr virus (EBV) usually occurs early in life. For several weeks to months after acute onset of the infection, it is spread by upper respiratory secretions that contain the virus.
Among the clinical disorders due to EBV infections, infectious mononucleosis is most common. Other disorders due to EBV infection have been recognized for several years, including African-type Burkitt lymphoma and nasopharyngeal carcinoma (NPC). The World Health Organization (WHO) classifies NPC as type 1 (keratinizing squamous cell carcinoma), type 2 (nonkeratinizing squamous cell carcinoma), and type 3 (undifferentiated carcinoma).
EBV infection also may cause lymphoproliferative syndromes, especially in patients who have undergone renal or bone marrow transplantation and in those who have AIDS.
Presence of IgA class antibody to the viral capsid antigen (VCA) of Epstein-Barr virus (EBV) indicates active EBV replication.
High levels of IgA class antibody to the VCA support the clinical diagnosis of nasopharyngeal carcinoma (NPC). These antibodies are present in 84% of patients with type 2 NPC.
IgA directed against VCA is positive for type 1 carcinoma in only 16% of cases.
The specificity of the test is such that 82% to 91% of healthy blood donors and patients who do not have NPC have negative responses.
IgA antibodies to viral capsid antigen (VCA) may be present during active Epstein-Barr virus (EBV) infection or reactivation. Diagnosis of EBV-associated nasopharyngeal carcinoma requires correlation with clinical presentation and additional laboratory findings (eg EBV-specific histopathology, etc).
De Paschale M, Clerici P: Serologic diagnosis of Epstein-Barr virus infection: Problems and solutions. World J Virol 2012;1(1):31-43