Somatostatin receptor scintigraphy versus chromogranin A assay in the management of patients with neuroendocrine tumors of different types: clinical role
Somatostatin receptor scintigraphy versus chromogranin A assay in the management of patients with neuroendocrine tumors of different types: clinical role
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DOI：
10.1093/annonc/mdg279
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发表时间：
2003-07-01
影响因子：
50.5
通讯作者：
De Apollonia, L
中科院分区：
文献类型：
--
作者：
Cimitan, M;Buonadonna, A;De Apollonia, L
背景资料：通过引入血浆或血清中的嗜铬粒蛋白A（CgA）测定作为肿瘤标记物，以及通过使用生长抑素受体荧光造影术（SRS）进行肿瘤定位，显著改善了神经内分泌肿瘤（NET）的当前诊断和分期。然而，CgA检测与SRS在NETs管理中的临床作用还没有得到很好的阐明。患者和方法：63例连续的NET组织学诊断患者进行了血浆CgA检测和SRS肿瘤分期（23例），肿瘤反应（18例）和后续肿瘤复发的评价（22例）。21例患者为分化良好的神经内分泌肿瘤（WDN：18例胃肠胰腺肿瘤和3例肺NET）; 22例患者患有高分化神经内分泌癌（WDNEC：17例胃肠胰腺癌，2例肺神经内分泌癌和3例起源不明的神经内分泌癌）和20例低分化神经内分泌癌患者（PDNEC：14例肺外小细胞癌和6例默克尔细胞癌）。几乎所有（63个中的58个）母语英语教师都无法工作。使用酶免疫测定法定量测定血浆中的CgA，临界值固定为34 U/l。用铟111-DTPA-奥曲肽（In-111-pentetreotide）的闪烁包括全身图像和胸部和腹部的单光子发射计算机断层扫描（SPECT）扫描。根据最终临床数据，SRS和CgA的总体灵敏度分别为77%和55%，而SRS和CgA的特异性均为94%。关于肿瘤类型，SRS的准确性为WDNELT 95%，WDNECs 86%，PDNECs 60%; CgA的准确性为WDNELT 76%，WDNECs 68%，PDNECs 50%。关于疾病的程度，SRS的敏感性为100%，为有限的疾病和72%，为先进的疾病; CGA的敏感性为43%，为有限的疾病和57%，为先进的diseases.Conclusions：在我们的NET系列，SRS被证明是更敏感比CGA，具有同等的特异性。肿瘤分化影响SRS和CgA分析的灵敏度。此外，血浆CgA水平与肿瘤分泌活性有关。尽管如此，SRS和CgA都应被认为是NET患者诊断检查的有用工具。
Background: Current diagnosis and staging of neuroendocrine tumors (NETs) are significantly improved by the introduction of the chromogranin A (CgA) assay in plasma or serum as a tumor marker, and by the use of somatostatin receptor scintigraphy (SRS) for tumor localization. However, the clinical role of CgA assay compared with SRS in the management of NETs has not been well elucidated.Patients and methods: Sixty-three consecutive patients with a histological diagnosis of NET underwent plasma CgA assay and SRS for tumor staging (23 cases), evaluation of tumor response (18 cases) and evaluation of tumor recurrence on follow-up (22 cases). Twenty-one patients had well-differentiated neuroendocrine tumors (WDNETs: 18 gastroenteropancreatic tumors and three lung NETs); 22 patients had well-differentiated neuroendocrine carcinomas (WDNECs: 17 gastroenteropancreatic carcinomas, two lung neuroendocrine carcinomas and three neuroendocrine carcinomas of unknown origin) and 20 patients had poorly differentiated neuroendocrine carcinomas (PDNECs: 14 extra-pulmonary small-cell carcinomas and six Merkel cell carcinomas). Almost all (58 of 63) NETs were non-functioning. The quantitative determination of CgA was performed in plasma using an enzyme immunoassay with a cut-off value fixed at 34 U/l. Scintigraphies with indium 111-DTPA-octreotide (In-111-pentetreotide) included whole-body images and single photon emission computed tomography (SPECT) scans of the chest and abdomen.Results: SRS results were compared with CgA findings and final clinical data. The overall sensitivity of SRS and CgA, based on the final clinical data, was 77% and 55%, respectively, whereas the specificity of both SRS and CgA was 94%. Concerning tumor type, SRS accuracy was 95% for WDNETs, 86% for WDNECs and 60% for PDNECs; CgA accuracy was 76% for WDNETs, 68% for WDNECs and 50% for PDNECs. With regard to disease extent, SRS sensitivity was 100% for limited disease and 72% for advanced disease; CgA sensitivity was 43% for limited disease and 57% for advanced disease.Conclusions: In our NET series, SRS proved to be more sensitive than CgA, with equivalent specificity. Tumor differentiation influences the sensitivity of SRS and CgA analysis. In addition, the plasma CgA level is related to tumor secretory activity. Nevertheless both SRS and CgA should be considered useful tools in the diagnostic work-up of NET patients.