From the Regional Regulatory Peptide Laboratory, Kelvin Building, NET Specialist Group, Royal Victoria Hospital Belfast NHS Trust, Belfast BT12 6BA, Northern Ireland, UK, Queen's University Belfast, Institute of Clinical Science, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland, UK and
From the Regional Regulatory Peptide Laboratory, Kelvin Building.
QJM. 2016 Feb;109(2):111-5. doi: 10.1093/qjmed/hcv095. Epub 2015 May 15.
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.
To clarify the relevance of NET biomarkers for diagnosis of small bowel NETs.
A review of laboratory test results.
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.
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.
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.
小肠神经内分泌肿瘤（NET）的诊断较为困难，因为其症状不具有特异性，且更常见于常见的胃肠道疾病中。嗜铬粒蛋白 A（CGA）、尿 5-羟吲哚乙酸（U-5HIAA）和神经激肽 A（NKA）被用作实验室诊断测试，但结果可能会产生误导或混淆。
阐明 NET 生物标志物在小肠 NET 诊断中的相关性。
对实验室检测结果的回顾。
我们回顾了北爱尔兰 500 例连续出现升高的血浆 CGA、U-5HIAA 和血浆 NKA 的患者的结果。NET 的诊断通过北爱尔兰癌症登记处得到确认。
在 500 例记录 CGA 升高的标本中，52.2%来自 NET 患者，其中 13.6%为小肠肿瘤，5.4%来自自身免疫性萎缩性胃炎患者，15.4%来自服用质子泵抑制剂的患者。在 500 例 U-5HIAA 升高的标本中，87.8%来自 NET 患者，其中 68.2%为小肠肿瘤。肺 NET 占 12.2%，其他部位 NET 占 7.4%。在 500 例 NKA 升高的标本中（参考范围（RR）>20ng/L），72.6%来自小肠 NET 患者，6%来自其他 NET 患者。在 20%的标本中，NKA 浓度为 21-23ng/L，处于检测精度范围内。
尽管只有一半的升高测试结果归因于 NET，CGA 仍然是 NET 的最佳通用循环标志物。U-5HIAA 是小肠和肺 NET 的极佳标志物，80%的高测试结果证实了这些诊断。NKA 是小肠 NET 最具特异性的生物标志物。
