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- Title
Neuroendocrine tumours of the small bowel: interpretation of raised circulating chromogranin A, urinary 5 hydroxy indole acetic acid and circulating neurokinin A.
- Authors
Ardill, J. E. S.; Armstrong, L.; Smye, M.; Doherty, R.; McCance, D. R.; Johnston, B. T.
- Abstract
Background: Neuroendocrine tumours (NETs) of the small bowel are difficult to diagnose as symptoms are non-specific and more often found in common gastrointestinal diseases. Chromogranin A (CGA), urinary 5 hydroxy indole acetic acid (U-5HIAA) and Neurokinin A (NKA) are used as laboratory diagnostic tests but results may be misleading or confusing. Aim: To clarify the relevance of NET biomarkers for diagnosis of small bowel NETs. Design: A review of laboratory test results. Methods: We reviewed 500 consecutive raised plasma CGA, U-5HIAA and plasma NKA, results from patients in N Ireland. The diagnosis of NET was confirmed by the Northern Ireland Cancer Registry. Results: In 500 specimens recording raised CGA, 52.2% were from patients with NETs, 13.6% being small bowel tumours, 5.4% of specimens from patients with auto-immune atrophic gastritis and 15.4% from patients taking proton pump inhibitors. In 500 specimens with raised U-5HIAA, 87.8% were from patients with NETs, 68.2% being small bowel tumours. Lung NETs contributed 12.2% and NETs from other sites, 7.4%. Of 500 specimens with raised NKA (reference range (RR)>20 ng/L), 72.6% were from patients with small bowel NETs and 6% specimens from patients with other NETs. In 20% of specimens NKA concentrations were 21-23 ng/L, within limits of assay precision. Conclusion: CGA remains the best general circulating marker for NETs although only half of raised test results are due to an NET. U-5HIAA is an excellent marker for small bowel and lung NETs with 80% of high test results confirming these diagnoses. NKA is the most specific biomarker for small bowel NETs.
- Subjects
NEUROENDOCRINE tumors; SMALL intestine cancer; CHROMOGRANINS; INDOLEACETIC acid; NEUROKININ A; GASTROINTESTINAL diseases; ROUTINE diagnostic tests; BIOMARKERS; DIAGNOSIS
- Publication
QJM: An International Journal of Medicine, 2016, Vol 109, Issue 2, p111
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hcv095