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Most NPC patients are diagnosed at late stage due to inconspicuous symptoms at the early stage, and the prognosis of these patients is poor. The early diagnosis rate of NPC could be significantly increased by serological screening, but the positive predictive value (PPV) is relatively low. A simple two\u2010step serological screening scheme was established to improve the PPV of the screening strategy and was validated by a prospective cohort. Serum antibodies specific for EBNA1, Zta, Thymidine Kinase (TK), EAD, EAR, and VCA were detected by enzyme\u2010linked immunosorbent assay. The combination of EBNA1\/IgA and VCA\/IgA was used in the first step of screening, and anti\u2010early antigens (EAs) were used in the second step of screening. EAD\/IgA was the most prominent marker in the second step of screening, and other anti\u2010EAs were complementary to EAD\/IgA. As validated by a prospective cohort including 4200 participants, using the combination of EAD\/IgA and TK\/IgA in the second step decreased the number of high\u2010risk participants from 128 to 27, and increased the PPV from 4.69% to 18.52%, with only one very early\u2010stage case missed. The two\u2010step screening scheme provides a standardized approach for NPC screening with an improved PPV and may be used in future field studies. With this two\u2010step serological screening method, more people benefit from the screening program without increasing the need for fiberoptic endoscopy.<\/jats:p>","DOI":"10.1002\/cam4.1345","type":"journal-article","created":{"date-parts":[[2018,2,26]],"date-time":"2018-02-26T02:42:25Z","timestamp":1519612945000},"page":"1458-1467","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Establishment and validation of a two\u2010step screening scheme for improved performance of serological screening of nasopharyngeal carcinoma"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0685-2549","authenticated-orcid":false,"given":"Tingdong","family":"Li","sequence":"first","affiliation":[{"name":"State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious Diseases School of Public Health and School of Life Science Xiamen University  Xiamen Fujian China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyi","family":"Guo","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious Diseases School of Public Health and School of Life Science Xiamen University  Xiamen Fujian China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingfang","family":"Ji","sequence":"additional","affiliation":[{"name":"Cancer Research Institute of Zhongshan City  Zhongshan Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fugui","family":"Li","sequence":"additional","affiliation":[{"name":"Cancer Research Institute of Zhongshan City  Zhongshan Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious Diseases School of Public Health and School of Life Science Xiamen University  Xiamen Fujian China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weimin","family":"Cheng","sequence":"additional","affiliation":[{"name":"Cancer Research Institute of Zhongshan City  Zhongshan Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Honglin","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Emerging Infectious Diseases Department of Microbiology Li Ka Shing, Faculty of Medicine The University of Hong Kong  Hong Kong SAR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munhon","family":"Ng","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious Diseases School of Public Health and School of Life Science Xiamen University  Xiamen Fujian China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shengxiang","family":"Ge","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious Diseases School of Public Health and School of Life Science Xiamen University  Xiamen Fujian China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Yuan","sequence":"additional","affiliation":[{"name":"Cancer Research Institute of Zhongshan City  Zhongshan Guangdong China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ningshao","family":"Xia","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics National Institute of Diagnostics and Vaccine Development in Infectious Diseases School of Public Health and School of Life Science Xiamen University  Xiamen Fujian China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,2,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canlet.2016.01.040"},{"key":"e_1_2_7_3_1","first-page":"355","article-title":"Nasopharyngeal carcinoma: presenting symptoms and duration before diagnosis","volume":"3","author":"Lee A. 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