Lenders Jacques W M, Pacak Karel, Walther McClellan M, Linehan W Marston, Mannelli Massimo, Friberg Peter, Keiser Harry R, Goldstein David S, Eisenhofer Graeme
Department of Internal Medicine, St Radboud University Medical Center, Geert Grooteplein Zuid 8, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
JAMA. 2002 Mar 20;287(11):1427-34. doi: 10.1001/jama.287.11.1427.
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.
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.
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.
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.
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.
嗜铬细胞瘤的诊断依赖于肿瘤产生儿茶酚胺的生化证据。然而，尚未确定用于确诊的最佳检测方法。
确定能为嗜铬细胞瘤诊断提供最佳方法的生化检测或检测组合。
设计、地点和参与者：1994年至2001年间在4个转诊中心对嗜铬细胞瘤患者进行检测的多中心队列研究。分析包括214例确诊为嗜铬细胞瘤的患者和644例经确定未患该肿瘤的患者。
使用血浆游离甲氧基肾上腺素、血浆儿茶酚胺、尿儿茶酚胺、尿总甲氧基肾上腺素及分馏甲氧基肾上腺素和尿香草扁桃酸，检测不同检测前患病率时的敏感性和特异性、受试者工作特征曲线以及阳性和阴性预测值。
血浆游离甲氧基肾上腺素（99%[95%置信区间[CI]，96%-100%]）和尿分馏甲氧基肾上腺素（97%[95%CI，92%-99%]）的敏感性高于血浆儿茶酚胺（84%[95%CI，78%-89%]）、尿儿茶酚胺（86%[95%CI，80%-91%]）、尿总甲氧基肾上腺素（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%]）和尿总甲氧基肾上腺素（93%[95%CI，89%-97%]）的特异性最高；血浆游离甲氧基肾上腺素（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%]）的特异性中等；尿分馏甲氧基肾上腺素（69%[95%CI，64%-72%]）的特异性最低。使用受试者工作特征曲线分析，不同上限参考值时血浆游离甲氧基肾上腺素的敏感性和特异性值最高。联合不同检测方法并未使诊断率高于单一的血浆游离甲氧基肾上腺素检测。
血浆游离甲氧基肾上腺素为排除或确诊嗜铬细胞瘤提供了最佳检测方法，应作为该肿瘤诊断的首选检测方法。
