Biochemical diagnosis of pheochromocytoma - Which test is best?
Biochemical diagnosis of pheochromocytoma - Which test is best?
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DOI：
10.1001/jama.287.11.1427
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发表时间：
2002-03-20
影响因子：
120.7
通讯作者：
Eisenhofer, G
中科院分区：
文献类型：
--
作者：
Lenders, JWM;Pacak, K;Eisenhofer, G
背景 嗜铬细胞瘤的诊断取决于肿瘤产生儿茶酚胺的生化证据。然而，确定诊断的最佳测试尚未确定。目的确定为诊断嗜铬细胞瘤提供最佳方法的生化测试或测试组合。设计、设置和参与者对 1994 年至 2001 年间在 4 个转诊中心进行嗜铬细胞瘤测试的患者进行多中心队列研究。该分析包括 214 名确诊为嗜铬细胞瘤的患者和 644 名被确定没有嗜铬细胞瘤的患者。肿瘤,主要结果指标 使用血浆游离变肾上腺素、血浆儿茶酚胺、尿儿茶酚胺、尿总和分级变肾上腺素以及尿香草扁桃酸测试敏感性和特异性、受试者操作特征曲线以及不同预检患病率的阳性和阴性预测值。 结果 血浆游离变肾上腺素（99% [95% 置信区间 {CI}, 96%-100%]）和尿分级的敏感性变肾上腺素（97% [95% CI 92%-99%]）高于血浆儿茶酚胺（84% [95% CI, 78%-89%]）、尿儿茶酚胺（86% [95% CI, 80%-91%]）、尿总变肾上腺素（77% [95% CI, 68%-85%]）和尿香草扁桃酸（64% [95% CI，55%-71%]）。尿香草扁桃酸 (95% [95% CI, 93%-97%]) 和尿总变肾上腺素 (93% [95% CI, 89%-97%]) 的特异性最高；血浆游离变肾上腺素（89% [95% CI, 87%-92%]）、尿儿茶酚胺（88% [95% CI, 85%-91%]）和血浆儿茶酚胺（81% [95% CI, 78%-84%]）的中间体；尿中分离的变肾上腺素最低（69% [95% CI, 64%-72%]）。使用接受者操作特征曲线，不同参考上限的灵敏度和特异性值对于血浆游离变肾上腺素是最高的。结合不同的测试并没有比单独的血浆游离变肾上腺素测试提高诊断率。结论血浆游离变肾上腺素提供了排除或确认嗜铬细胞瘤的最佳测试，应该是诊断肿瘤的首选测试。
Context Diagnosis of pheochromocytoma depends on biochemical evidence of catecholamine production by the tumor. However, the best test to establish the diagnosis has not been determined.Objective To determine the biochemical test or combination of tests that provides the best method for diagnosis of pheochromocytoma.Design, Setting, and Participants Multicenter cohort study of patients tested for pheochromocytoma at 4 referral centers between 1994 and 2001. The analysis included 214 patients in whom the diagnosis of pheochromocytoma was confirmed and 644 patients who were determined to not have the tumor,Main Outcome Measures Test sensitivity and specificity, receiver operating characteristic curves, and positive and negative predictive values at different pretest prevalences using plasma free metanephrines, plasma catecholamines, urinary catecholamines, urinary total and fractionated metanephrines, and urinary vanillylmandelic acid.Results Sensitivities of plasma free metanephrines (99% [95% confidence interval {CI}, 96%-100%]) and urinary fractionated metanephrines (97% [95% CI 92%-99%]) were higher than those for plasma catecholamines (84% [95% CI, 78%-89%]), urinary catecholamines (86% [95% CI, 80%-91%]), urinary total metanephrines (77% [95% CI, 68%-85%]), and urinary vanillylmandelic acid (64% [95% CI, 55%-71%]). Specificity was highest for urinary vanillylmandelic acid (95% [95% CI, 93%-97%]) and urinary total metanephrines (93% [95% CI, 89%-97%]); intermediate for plasma free metanephrines (89% [95% CI, 87%-92%]), urinary catecholamines (88% [95% CI, 85%-91%]), and plasma catecholamines (81% [95% CI, 78%-84%]); and lowest for urinary fractionated metanephrines (69% [95% CI, 64%-72%]). Sensitivity and specificity values at different upper reference limits were highest for plasma free metanephrines using receiver operating characteristic curves. Combining different tests did not improve the diagnostic yield beyond that of a single test of plasma free metanephrines.Conclusion Plasma free metanephrines provide the best test for excluding or confirming pheochromocytoma and should be the test of first choice for diagnosis of the tumor.